Lower-dose epinephrine administration and out-of-hospital cardiac arrest outcomes.
Resuscitation
; 124: 43-48, 2018 03.
Article
in En
| MEDLINE
| ID: mdl-29305926
ABSTRACT
BACKGROUND:
International guidelines recommend administration of 1â¯mg of intravenous epinephrine every 3-5â¯min during cardiac arrest. The optimal dose of epinephrine is not known. We evaluated the association of reduced frequency and dose of epinephrine with survival after out-of-hospital cardiac arrest (OHCA).METHODS:
Included were patients with non-traumatic OHCA treated by advanced life support (ALS) providers from January 1, 2008 to June 30, 2016. During the before period, providers were instructed to give epinephrine 1â¯mg intravenously at 4â¯min followed by additional 1â¯mg doses every eight minutes to patients with OHCA with a shockable rhythm and 1â¯mg doses every two minutes to patients with a non-shockable rhythm (higher dose). On October 1, 2012, providers were instructed to reduce the dose of epinephrine treatment during out-of-hospital cardiac arrest (OHCA) 0.5â¯mg at 4 and 8â¯min followed by additional doses of 0.5â¯mg every 8â¯min for shockable rhythms and 0.5â¯mg every 2â¯min for non-shockable rhythms (lower dose). Patients with shockable initial rhythms were analyzed separately from those with non-shockable initial rhythms. The primary outcome was survival to hospital discharge with a secondary outcome of favorable neurological status (Cerebral Performance Category [CPC] 1 or 2) at hospital discharge. Multiple logistic regression modeling was used to adjust for age, sex, presence of a witness, bystander CPR, and response interval.RESULTS:
2255 patients with OHCA were eligible for analysis. Of these, 24.6% had an initially shockable rhythm. Total epinephrine dose per patient decreased from a mean⯱â¯standard deviation of 3.4⯱â¯2.3â¯mg-2.6⯱â¯1.9â¯mg (pâ¯<â¯0.001) in the shockable group and 3.5⯱â¯1.9â¯mg-2.8⯱â¯1.7â¯mg (pâ¯<â¯0.001) in the non-shockable group. Among those with a shockable rhythm, survival to hospital discharge was 35.0% in the higher dose group vs. 34.2% in the lower dose group. Among those with a non-shockable rhythm, survival was 4.2% in the higher dose group vs. 5.1% in the lower dose group. Lower dose vs. higher dose was not significantly associated with survival adjusted odds ratio, aOR 0.91 (95% CI 0.62-1.32, pâ¯=â¯0.61) if shockable and aOR 1.26 (95% CI 0.79-2.01, pâ¯=â¯0.33) if non-shockable. Lower dose vs. higher dose was not significantly associated with favorable neurological status at discharge aOR 0.84 (95% CI 0.57-1.24, pâ¯=â¯0.377) if shockable and aOR 1.17 (95% CI 0.68-2.02, pâ¯=â¯0.577) if non-shockable.CONCLUSION:
Reducing the dose of epinephrine administered during out-of-hospital cardiac arrest was not associated with a change in survival to hospital discharge or favorable neurological outcomes after OHCA.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Vasoconstrictor Agents
/
Epinephrine
/
Out-of-Hospital Cardiac Arrest
Type of study:
Guideline
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Resuscitation
Year:
2018
Document type:
Article
Affiliation country:
Publication country:
IE
/
IRELAND
/
IRLANDA