Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients? | Journal Scan
What is the effect of epinephrine on recovery during the post-cardiac arrest phase?
The authors assessed the impact of epinephrine on outcome of all patients with out-of-hospital cardiac arrest (OHCA) with successful resuscitation who were admitted to a cardiac arrest center from January 2000 to May 2012. Epinephrine use was evaluated as present or absent and by dose (none, 1 mg, 2-5 mg, or >5 mg). Favorable discharge outcome was coded using a Cerebral Performance Category 1 or 2.
Among 1,556 eligible patients, 1,134 (73%) received epinephrine. Treatment with epinephrine was associated with a good outcome in 19% compared with 63% of the untreated group (p < 0.001). The adverse association of epinephrine was observed regardless of length of resuscitation or in-hospital interventions performed. Compared to patients who did not receive epinephrine, the adjusted odds ratio of intact survival was 0.48 (95% confidence interval [CI], 0.27-0.84) for 1 mg epinephrine, 0.30 (95% CI, 0.20-0.47) for 2-5 mg epinephrine, and 0.23 (95% CI, 0.14-0.37) for >5 mg epinephrine dose. Delayed administration of epinephrine was associated with worse outcome.
Prehospital epinephrine was associated with a lower chance of survival and neurological recovery among patients admitted with OHCA.
The association between epinephrine use and poor worse survival among patients who survive OHCA has been consistently demonstrated in multiple observational studies. However, it is not clear if it is the epinephrine, or the need for epinephrine, that explains this association. In a randomized trial that was stopped prematurely, use of epinephrine was associated with improved return of spontaneous circulation, but not in survival to hospital discharge (Jacobs IG, et al., Resuscitation 2011;82:1138-43). The role of epinephrine in the management of cardiac arrest, while routine, is not supported by high-quality data, and the results of the ongoing ‘PARAMEDIC 2: The Adrenaline Trial’ will help clarify the role of epinephrine in this population.
Keywords: Out-of-Hospital Cardiac Arrest, Epinephrine, Heart Arrest, Resuscitation
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