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Sudden cardiac arrest pharmacotherapy with prefilled syringes improves adherence to Advanced Life Support protocol in understaffed resuscitation pre-hospital care teams

  • Radoslaw Zalewski1
  • Wojciech Telec2
  • Mateusz Puslecki1,3
  • Marek Dabrowski4
  • Bartlomiej Perek3
  • Lukasz Szarpak5,6

1Department of Medical Rescue, Chair of Emergency Medicine, Poznań University of Medical Sciences, Poland

2Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poland

3Department of Cardiac Surgery and Transplantology, Chair of Cardiac and Thoracic Surgery, Poznan University of Medical Sciences, Poland

4Department of Medical Education, Poznan University of Medical Sciences, Poland

5Maria Skłodowska-Curie Medical Academy in Warsaw, Warsaw, Poland

6Bialystok Oncology Center, Bialystok, Poland

DOI: 10.22514/sv.2020.16.0098 Vol.17,Issue 1,January 2021 pp.69-74

Published: 08 January 2021

*Corresponding Author(s): Radoslaw Zalewski E-mail:


Every procedural facilitation or a change in available equipment in treatment of out-of-hospital arrest (OHCA) by two-person teams may significantly enhance their performance quality. The aim of this study was to assess the impact of adrenaline in prefilled syringes on improving the adherence to Advanced Life Support protocol by understaffed teams. The research was based on a randomized cross-over high-fidelity simulation study. Two-person teams took part in two 10-minute simulation scenarios featuring sudden cardiac arrest in ventricular fibrillation (VF). The control group (group C) had at its disposal standard ampoules, whereas the experimental group (group E) prefilled syringes. The execution times of CPR start, defibrillation shocks, intravenous (IV) access, epinephrine and amiodarone doses were measured. Additionally, the chest compression fraction (CCF) was calculated. The designed two-minute loops were considerably prolonged in group C. Nineteen teams (31.1%) in group C but 49 (80.3%) in group E carried out the fifth defibrillation (P < 0.001). After two minutes of CPR nobody in group C switched to perform chest compressions. IV access was obtained significantly earlier in group E (114.7 ± 52.2 sec) than in group C (150.2 ± 68.6 sec)(P = 0.002). Two doses of adrenaline were administered in group E, whereas its second dose only by 12 teams in group C. The simulation study has proved that for understaffed teams a use of prefilled syringes not only did enhance the flow of ALS procedure, but it also improved the quality of cardiopulmonary resuscitation.


Sudden cardiac arrest; Cardiopulmonary resuscitation; Simulation; Prefilled syringes; Epinephrine; Paramedic

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Radoslaw Zalewski,Wojciech Telec,Mateusz Puslecki,Marek Dabrowski,Bartlomiej Perek,Lukasz Szarpak. Sudden cardiac arrest pharmacotherapy with prefilled syringes improves adherence to Advanced Life Support protocol in understaffed resuscitation pre-hospital care teams. Signa Vitae. 2021. 17(1);69-74.


[1] Hayashi M, Shimizu W, Albert CM. The spectrum of epidemiology underlying sudden cardiac death. Circulation Research. 2015; 116: 1887-1906.

[2] Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. EuReCa ONE-27 Nations, ONE Europe, ONE registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016; 105: 188-195.

[3] Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: A clinical trial. Academic Emergency Medicine. 2016; 23: 448-454.

[4] Escutnaire J, Segal N, Menay M, Bargain P, Mannhart P, Caron J-C, et al. Abstract 19946: Airports: out-of-hospital chain of survival laboratory?Circulation. 2015; 132: A19946.

[5] Płaziak R. Healthcare financing in Poland in scope of Medical Rescue. Journal of Education, Health and Sport. 2019; 9: 21-39.

[6] Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, et al. Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest. The New England Journal of Medicine. 2016; 374: 1711-1722.

[7] Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European resuscitation council guidelines for resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015; 95: 100-147.

[8] Helm C, Gillett M. Adrenaline in cardiac arrest: Prefilled syringes are faster. Emergency Medicine Australasia. 2015; 27: 312-316.

[9] Dabrowski M, Sip M, Dabrowska A, Klosiewicz T, Zalewski R, Telec W, et al. It is impossible to follow the ERC algorithm in a two-paramedics ambulance team. Resuscitation. 2017; 118: e43.

[10] Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveen-gen T, et al. European resuscitation council guidelines for resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015; 95: 81-99.

[11] Gonzalez LS, Chaney MA, Wahr JA, Rebello E. What’s in that syringe?The Journal of Cardiothoracic and Vascular Anesthesia. 2020; 34: 2524-2531.

[12] Thomas AN. What’s in that syringe? Standard drug concentrations in critical care. Journal of the Intensive Care Society. 2017; 18: 8-10.

[13] Callaway CW. Epinephrine for cardiac arrest. Current Opinion in Cardiology. 2013; 28: 36-42.

[14] Pearson JW, Redding JS. The role of epinephrine in cardiac resuscitation. Anesthesia & Analgesia. 1963; 42: 599-606.

[15] Lin S, Callaway CW, Shah PS, Wagner JD, Beyene J, Ziegler CP, et al. Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials. Resuscitation. 2014; 85: 732-740.

[16] Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation. 2011; 82: 1138-1143.

[17] Hingley S, Booth A, Hodgson J, Langworthy K, Shimizu N, Maconochie I. Concordance between the 2010 and 2015 resuscitation guidelines of international liaison committee of resuscitation councils (ILCOR) mem-bers and the ILCOR consensus of science and treatment recommendations (CoSTRs). Resuscitation. 2020; 151: 111-117.

[18] Ornato JP, Peberdy MA, Reid RD, Feeser VR, Dhindsa HS, NRCPR Investigators. Impact of resuscitation system errors on survival from in-hospital cardiac arrest. Resuscitation. 2012; 83: 63-69.

[19] Zalewski R, Puślecki M, Kłosiewicz T, Sip M, Perek B. The use of prefilled adrenaline syringes improves cardiopulmonary resuscitation quality-high-fidelity simulator-based study. Journal of Thoracic Disease. 2020; 12: 2105-2112.

[20] Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009; 120: 1241-1247.

[21] Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al. CPR quality summit investigators, the American Heart Association emergency cardiovascular care committee, and the council on cardiopulmonary, critical care, perioperative and resuscitation. Cardiopulmonary resuscitation quality: (corrected) improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013; 128: 417-435.

[22] Robak O, Pruc M, Malysz M, Smereka J, Szarpak L, Bielski K, et al. Pre-filled syringes with adrenaline during cardiopulmonary resuscitation in nonshockable rhythms. Pilot randomised crossover simulation study. Disaster and Emergency Medicine Journal. 2020; 5: 79-84.

[23] Vilke GM, Tornabene SV, Stepanski B, Shipp HE, Ray LU, Metz MA, et al. Paramedic self-reported medication errors. Prehospital Emergency Care. 2007; 11: 80-84.

[24] Grochans E. Comparative analysis of pre-filled syringes and traditional equipment for nursing activities. Nursing Topics. 2013; 21: 98-107.

[25] Stevens AD, Hernandez C, Jones S, Moreira ME, Blumen JR, Hopkins E, et al. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial. Resuscitation. 2015; 96: 85-91.

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