Immediate survival among patients in cardiac arrest after three attempted direct current (DC) defibrillations for ventricular fibrillation (VF) or who are in asystole and receiving adequate cardiopulmonary resuscitation is less than 10%—the hospital discharge rate is less than 2%. Adrenaline is advocated to improve survival.

The recommended dose of adrenaline is 1 mg bolus administered intravenously repeated every three minutes as necessary. A prospective placebo controlled trial of “standard dose” adrenaline (0.01–0.02 mg/kg), however, has not been performed in patients with cardiac arrest. The effects of standard dose adrenaline have been analysed in a large retrospective study of 1360 patients with witnessed out-of-hospital VF.1 Some emergency medical staff were authorised to give standard doses of adrenaline during the observational period. Adrenaline was given to 35% of patients and was associated with a significantly greater rate of restoration of spontaneous circulation and hospital admission. However, there was no significant difference in hospital discharge rates between the two groups. Thus adrenaline and its dosage during cardiac arrest remain controversial.