Grant: Project Grant

Each year in Canada, there are over 40,000 people who collapse from cardiac arrest. Cardiac arrest is a sudden stoppage of the heart. This life threatening problem is treated by paramedics with CPR, shocks and drugs, including the routine use of adrenaline. The worldwide standard dose of adrenaline is 1mg every 3 to 5 minutes with no total limit. Although the standard dose of adrenaline can help restart the heart, half of these patients die in the hospital from irreversible brain injury and brain death. Despite decades of use, there is no proof that the standard dose of adrenaline is effective at improving survival out of the hospital and there is growing evidence suggesting that the standard dose of adrenaline may be harmful to the brain, particularly with higher total doses. Adrenaline increases blood flow to the heart to improve its chances to restart but when more than 2mg total of adrenaline is used, there is decreased blood flow to the brain leading to brain injury and brain death. We believe and would like to test how effective are low (optimal) doses (up to 2mg total) of adrenaline compared to the current standard doses (no total limit). We also want to test whether the low dose of adrenaline is better than nothing (placebo). We will test these three treatments in a large group of patients treated in an existing world-class Canadian out-of-hospital resuscitation research network called the Canadian Resuscitation Outcomes Consortium (CanROC) consisting of central and southern Ontario, and all of British Columbia. This will be the first clinical trial to test the effects of low dose adrenaline, the standard dose of adrenaline, and placebo in cardiac arrest. This research may improve patient survival and brain function after out-of-hospital cardiac arrest, and change the way in which cardiac arrest is treated worldwide.