Adrenaline for resuscitation: now even more questions than answers.

Adrenaline is a widely accepted drug and component of cardiopulmonary resuscitation. The guidelines for cardiopulmonary resuscitation published by the European Resuscitation Council and the International Liaison Committee on Resuscitation (ILCOR) in 2010 stated that, despite the widespread use of adrenaline during cardiopulmonary resuscitation and several studies involving vasopressin, no placebo-controlled study has shown that the routine use of any vasopressor at any stage during human cardiocirculatory arrest increases neurologically intact survival to hospital discharge. The present evidence is described as being insufficient to support or to refute the routine use of adrenaline. Nevertheless, adrenaline represents a cornerstone in the cardiopulmonary resuscitation algorithm. The guidelines also state that, despite the lack of human data, the use of adrenaline is recommended, based largely on animal data and increased short-term survival in humans. Up to now adrenaline has been inevitable, as a result of a ‘grandfather rule’, in cardiopulmonary resuscitation. We should remember that adrenaline has been used for more than five decades in cardiopulmonary resuscitation. Animal studies have shown the importance of vasopressors, and especially adrenaline, in a cardiocirculatory arrest model in rats and pigs. No animal with a cardiocirculatory arrest of 7-min duration could be resuscitated using placebo instead of a vasopressor during cardiopulmonary resuscitation. The main reason not to change the status of adrenaline was an ethical one; in addition, randomised placebo-controlled trials are impractical, adrenaline has a