ArticleWorld journal of critical care medicine2026
Impact of nurse empowerment for early adrenaline administration for in-hospital cardiac arrest resuscitation: A pre-post intervention study.
Article in World journal of critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTimely administration of adrenaline during in-hospital cardiac arrest (IHCA) with non-shockable rhythms is recommended, yet delays are common when drug administration depends on physician authorisation.
aimTo evaluate whether empowering nurses to administer the first dose of adrenaline could reduce delays and improve outcomes.
methodsIn this study of prospectively collected registry data, the primary outcome of time to first dose of adrenaline in IHCA events with non-shockable rhythms (asystole/pulseless electrical activity) was compared between the pre-intervention phase (September 1, 2018 to November 26, 2019), when adrenaline administration was physician-led, and the post-intervention phase (November 27, 2019 to December 31, 2021), when nurse-led administration of adrenaline without physician order was implemented. Secondary outcomes included return of spontaneous circulation (ROSC), time to ROSC, 24-hour survival, and survival to discharge. Logistic regression analysis was performed to assess for factors associated with ROSC and whether timely adrenaline administration (defined as within 2-minutes) was independently associated with ROSC.
resultsAmong 450 IHCA events, 162 occurred in the pre-intervention and 288 in the post- intervention period. The mean (standard deviation) age was 52.5 (16.1) years; 63.1% were male. Timely adrenaline administration improved from 46% in the pre-intervention period to 74.3% (
conclusionNurse-led early adrenaline administration during IHCA significantly reduced treatment delays and enhanced resuscitation efficiency, though it did not translate to reduced hospital mortality. This model is feasible in low- and middle-income settings and underscores the value of system-level empowerment to improve IHCA care.
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