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J Am Coll Cardiol. 2014 Dec 9;64(22):2360-7. doi: 10.1016/j.jacc.2014.09.036. Epub 2014 Dec 1.

Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients?

Author information

1
INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris Descartes University, Paris, France. Electronic address: florence.dumas@cch.aphp.fr.
2
INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France; Medical Intensive Care Unit, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
3
INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France; Emergency Medical Services, SAMU 75, Necker Hospital, APHP, Paris, France.
4
Medical Intensive Care Unit, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
5
Department of Cardiology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
6
INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France.
7
Emergency Medical Services, SAMU 75, Necker Hospital, APHP, Paris, France.
8
Emergency Medical Services, Division of Public Health for Seattle and King County, University of Washington, Seattle, Washington.

Abstract

BACKGROUND:

Although epinephrine is essential for successful return of spontaneous circulation (ROSC), the influence of this drug on recovery during the post-cardiac arrest phase is debatable.

OBJECTIVES:

This study sought to investigate the relationship between pre-hospital use of epinephrine and functional survival among patients with out-of-hospital cardiac arrest (OHCA) who achieved successful ROSC.

METHODS:

We included all patients with OHCA who achieved successful ROSC admitted to a cardiac arrest center from January 2000 to August 2012. Use of epinephrine was coded as yes/no and by dose (none, 1 mg, 2 to 5 mg, >5 mg). A favorable discharge outcome was coded using a Cerebral Performance Category 1 or 2. Analyses incorporated multivariable logistic regression, propensity scoring, and matching methods.

RESULTS:

Of the 1,556 eligible patients, 1,134 (73%) received epinephrine; 194 (17%) of these patients had a good outcome versus 255 of 422 patients (63%) in the nontreated group (p < 0.001). This adverse association of epinephrine was observed regardless of length of resuscitation or in-hospital interventions performed. Compared with patients who did not receive epinephrine, the adjusted odds ratio of intact survival was 0.48 (95% confidence interval [CI]: 0.27 to 0.84) for 1 mg of epinephrine, 0.30 (95% CI: 0.20 to 0.47) for 2 to 5 mg of epinephrine, and 0.23 (95% CI: 0.14 to 0.37) for >5 mg of epinephrine. Delayed administration of epinephrine was associated with worse outcome.

CONCLUSIONS:

In this large cohort of patients who achieved ROSC, pre-hospital use of epinephrine was consistently associated with a lower chance of survival, an association that showed a dose effect and persisted despite post-resuscitation interventions. These findings suggest that additional studies to determine if and how epinephrine may provide long-term functional survival benefit are needed.

KEYWORDS:

cardiac arrest; hypothermia; percutaneous coronary intervention

PMID:
25465423
DOI:
10.1016/j.jacc.2014.09.036
[Indexed for MEDLINE]
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