Research ArticleResearchWorkflowQuality Improvement

A nurse-led protocol shortened time to adrenaline during non-shockable in-hospital arrests

World journal of critical care medicine (PubMed)Sep 9, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A pre-post study of non-shockable in-hospital cardiac arrests found that allowing nurses to administer the first adrenaline dose under protocol shortened treatment time, without improving return of spontaneous circulation or survival.

What NurseJet pulled from the source

Across 450 arrests, adrenaline within two minutes increased from 46.0% before the protocol to 74.3% after it, and median time to the first dose fell from four minutes to two. Return of spontaneous circulation rates were similar, and timely administration was not independently associated with return of spontaneous circulation.

Why this matters for nurses

The study suggests that a formally authorized nurse-led resuscitation workflow can reduce a process delay, while showing that faster medication delivery alone did not translate into better survival in this observational comparison.

Bedside takeaway

Know the local first-dose authority and rehearse rapid team activation and reversible-cause assessment.

Key takeaways

The comparison included 162 pre-intervention and 288 post-intervention cardiac-arrest events.
Time to return of spontaneous circulation was shorter after implementation, but overall return-of-spontaneous-circulation rates did not differ significantly.
Timely adrenaline was associated with faster return of spontaneous circulation in combined data but did not improve survival.

Practice implications

Know who is authorized to give first-dose adrenaline during a code, rehearse the local non-shockable-arrest workflow, and prioritize rapid team activation and reversible-cause assessment within facility protocol.

Limitations & cautions

Abstract-only summary. This was a nonrandomized pre-post study spanning different time periods; other changes in staffing or resuscitation practice could have influenced results, and survival did not improve.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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World journal of critical care medicine (PubMed)

World journal of critical care medicine (PubMed). Impact of nurse empowerment for early adrenaline administration for in-hospital cardiac arrest resuscitation: A pre-post intervention study.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42707871/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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The Canadian journal of hospital pharmacy (PubMed)Sep 9, 2026Systematic Review

A systematic review and meta-analysis of five placebo-controlled randomized trials found lower mortality with intravenous hydrocortisone among neonates with hypotension, but the evidence base included only 239 patients.

Peds ICUAI summaryReview source

Systematic ReviewResearchMedication SafetyAI summary · original source linked below

The fixed-effect meta-analysis found an odds ratio for all-cause mortality of 0.48 with intravenous hydrocortisone versus placebo (95% CI 0.24 to 0.96), with low statistical heterogeneity. The authors state that larger trials are needed before the finding is considered confirmed.

Key takeaways

Five randomized, placebo-controlled trials with a total of 239 neonates were included.
The pooled mortality estimate favored hydrocortisone, but the confidence interval approached no difference.
The abstract addresses mortality only and does not provide pooled adverse-event or longer-term neurodevelopmental outcomes.

Why this matters on shift

Hydrocortisone may be considered when neonatal hypotension persists despite volume and vasoactive support, but this mortality signal comes from a small evidence base and should not be presented as definitive.

Bedside takeaway

Treat the mortality signal as promising but preliminary, and follow local NICU monitoring and escalation protocols.

Nursing implications

When hydrocortisone is ordered for refractory neonatal hypotension, continue close hemodynamic and medication monitoring and follow the NICU's dosing, glucose, electrolyte, and escalation protocols.

Limitations & cautions

Abstract-only summary. Only five trials and 239 neonates were pooled; the abstract does not report gestational-age subgroups, dosing differences, adverse events, or neurodevelopmental outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

The Canadian journal of hospital pharmacy (PubMed). Effect of IV Hydrocortisone on Mortality among Neonates with Hypotension: A Systematic Review and Meta-analysis of Randomized, Placebo-Controlled Trials.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

Telemetry Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyPatient EducationAI summary · original source linked below

Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Journal of neurosurgical anesthesiology (PubMed)Sep 4, 2026Research Article

A five-center randomized trial found similar rescue-opioid use and moderate-to-severe PACU pain with dexmedetomidine-based opioid-sparing analgesia and fentanyl-based analgesia during elective craniotomy for brain tumors.

Emergency ICUAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 500 adults. Moderate-to-severe PACU pain occurred in 145 of 242 assessed participants in the fentanyl group and 138 of 233 in the dexmedetomidine group, with no significant difference.

Key takeaways

Intraoperative rescue fentanyl use did not differ significantly between groups.
Hypotension was more common with dexmedetomidine, while postoperative shivering was less common.
Other in-hospital outcomes were similar between the two regimens.

Why this matters on shift

An opioid-sparing label did not translate into better early pain control in this trial, and the differing hypotension and shivering profiles remain relevant during perioperative handoff and recovery monitoring.

Bedside takeaway

Monitor pain, hemodynamics, sedation, and shivering in relation to the analgesic regimen and local protocol.

Nursing implications

During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of neurosurgical anesthesiology (PubMed). Opioid-Sparing Versus Opioid-Based Analgesia for Craniotomy: A Multicenter Randomized Controlled Trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Small neonatal trials suggest hydrocortisone may reduce mortality in refractory hypotension

Targeted vitamin D did not significantly reduce major cardiovascular events after MI

Dexmedetomidine did not improve early pain outcomes versus fentanyl for craniotomy