Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest

Study Questions:

Does the use of epinephrine during cardiopulmonary resuscitation (CPR) affect outcomes in patients with out-of-hospital cardiac arrest (OHCA)?

Methods:

The data for this observational study were obtained from a registry of 417,188 patients (mean age 72 years) with OHCA. Epinephrine was administered during CPR in 15,030 patients and was not administered in the remaining 402,158 patients. A propensity score for epinephrine administration was used to control for potential confounding variables.

Results:

Return of spontaneous circulation (ROSC) before hospitalization occurred significantly more often in the epinephrine group (18.3%) than in the propensity-matched nonepinephrine group (10.5%). One-month survival without severe cerebral dysfunction was significantly lower in the epinephrine group (1.3%) than in the propensity-matched nonepinephrine group (3.1%).

Conclusions:

Administration of epinephrine during CPR in patients with OHCA is associated with a higher probability of ROSC before hospitalization, but a lower 1-month rate of survival without severe cerebral dysfunction.

Perspective:

By redirecting peripheral blood flow, epinephrine increases coronary and cerebral perfusion. This could explain why epinephrine improved the probability of ROSC before hospitalization in this study. Prior studies on the affect of epinephrine on 1-month survival have reported conflicting results. This study strengthens the case for avoiding epinephrine use in patients with OHCA. The reasons that epinephrine compromises 1-month survival could include increased myocardial dysfunction, impaired cerebral microcirculation, and/or an increased risk of ventricular tachycardia/ventricular fibrillation after resuscitation.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias

Keywords: Registries, Confounding Factors (Epidemiology), Tachycardia, Ventricular, Resuscitation, Propensity Score, Out-of-Hospital Cardiac Arrest, Epinephrine, Microcirculation, Ventricular Fibrillation, Cardiopulmonary Resuscitation, Hospitalization


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