HMN 2026: How Adrenaline restarts the heart after in-hospital cardiac arrest

Giving adrenaline to hospital patients whose heart has stopped is very effective, and can increase the chance of bringing their heart rate back to normal by a factor of five.

When a patient’s heart stops in a hospital, health care professionals need to act quickly.

“They immediately start cardiopulmonary resuscitation with breathing and chest compression, and connect to a defibrillator,” says Eirik Skogvoll, a senior consultant at the Department of Anesthesia and Intensive Care Medicine at St. Olavs Hospital.

But this is not always enough.

“If this does not get the heart going, we give the patient adrenaline intravenously,” Skogvoll said.

Adrenaline

• Adrenaline is a hormone that our bodies produce.
• It usually prepares the body to fight or flee in stressful situations by increasing heart rate and blood pressure, expanding the airways, and directing blood flow away from digestion and toward the muscles and heart.
• Adrenaline also releases the glucose to give us more energy, making you more alert, and can make you physically stronger for a short period.

Adrenaline in crisis

The fact that adrenaline also works to get the heart going in the event of cardiac arrest has long been a kind of accepted truth among health professionals. Many people are familiar with adrenaline from its use in treating anaphylactic shock, a severe allergic reaction that can be deadly. Adrenaline has been used in this context to resuscitate patients for more than 50 years.

Adrenaline is also well documented as used in an ambulance, outside hospitals. However, the extent to which adrenaline works in cardiac arrest in hospital has not been directly investigated—until now.

“The effect of adrenaline in this situation has so far not been unambiguously documented,” said Skogvoll, who is also a professor at the Department of Circulation and Medical Imaging at NTNU.

Now, in a study from St. Olavs Hospital and NTNU, anesthesiologist Anders Norvik and the hospital’s emergency team have shown how effective adrenaline actually is, even with relatively few patients.

The study is published in Resuscitation Plus.

Adrenaline acts almost immediately

“We found that adrenaline works within one minute. This increases the chance of the patient regaining their pulse five-fold,” Norvik said. This is the first step for the patient to survive.

In other words, these are very convincing results.

Skogvoll and Norvik’s research group can finally prove what many have believed, because health care professionals accurately recorded the timing of the use of adrenaline during resuscitation attempts. Further statistical analysis could thus distinguish opinion from knowledge.

The first dose is what counts

But there is also a limit to how useful adrenaline is.

“If the patient does not respond to the first dose, it’s not very useful to give more doses,” Norvik said. He added that this result is less certain.

However, the first dose of adrenaline is the one that works best.

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