Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation
Introduction: Epinephrine continues to be a fundamental part of the Advanced Cardiac Life Support algorithm despite a lack of evidence that it improves neurologically intact survival. Our aim was both to identify a potential upper limit of epinephrine use in resuscitations and to demonstrate real-wo...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2023-11-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/656854c1 |
| _version_ | 1827386572432998400 |
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| author | Zachary Boivin Kevin M. Duignan Donias Doko Nicholas Pugliese Trent She |
| author_facet | Zachary Boivin Kevin M. Duignan Donias Doko Nicholas Pugliese Trent She |
| author_sort | Zachary Boivin |
| collection | DOAJ |
| description | Introduction: Epinephrine continues to be a fundamental part of the Advanced Cardiac Life Support algorithm despite a lack of evidence that it improves neurologically intact survival. Our aim was both to identify a potential upper limit of epinephrine use in resuscitations and to demonstrate real-world epinephrine use in different patient subgroups. Methods: This was a single-center, retrospective cohort study, conducted between August 1, 2016–July 1, 2021, of patients with medical cardiac arrest who were administered a known number of epinephrine doses. The primary outcome was neurologically intact discharge defined by a modified Rankin scale ≤3, with secondary outcomes of comparing epinephrine doses by age, rhythm, and emergency medical services vs emergency department administration of epinephrine. Results: The study included 1,330 patients, with 184 patients (13.8%) surviving to neurologically intact discharge. The primary outcome of neurologically intact discharge was found in 89 (65.4%) patients in the zero epinephrine dose group, 75 (20.0%) in the 1-3 dose group, 15 (4.3%) in the 4-6 dose group, and one (0.002%) in the ≥7 dose group (P < 0.001). Patients received similar amounts of epinephrine when stratified by age, while patients with shockable rhythms received more epinephrine than patients with non-shockable rhythms. Conclusion: There was a significant decrease in neurologically intact discharge with increasing number of epinephrine doses, and our data suggests that seven or more doses of epinephrine is almost always futile. While further prospective studies are needed, clinicians should consider epinephrine doses when weighing the futility or benefit of continued resuscitation efforts. |
| first_indexed | 2024-03-08T15:47:18Z |
| format | Article |
| id | doaj.art-f0a8686bb8124e4c8c439e4f74997f87 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-03-08T15:47:18Z |
| publishDate | 2023-11-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-f0a8686bb8124e4c8c439e4f74997f872024-01-09T10:34:55ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182023-11-012461025103310.5811/westjem.6084060840Epinephrine in Cardiac Arrest: Identifying a Potential Limit for ResuscitationZachary Boivin0Kevin M. Duignan1Donias Doko2Nicholas Pugliese3Trent She4University of Connecticut, Emergency Medicine Residency, Farmington, ConnecticutUniversity of Connecticut, Emergency Medicine Residency, Farmington, ConnecticutUniversity of Connecticut, Emergency Medicine Residency, Farmington, ConnecticutCooper University Hospital, Department of Pharmacy, Camden, New JerseyHartford Hospital, Department of Emergency Medicine, Hartford, ConnecticutIntroduction: Epinephrine continues to be a fundamental part of the Advanced Cardiac Life Support algorithm despite a lack of evidence that it improves neurologically intact survival. Our aim was both to identify a potential upper limit of epinephrine use in resuscitations and to demonstrate real-world epinephrine use in different patient subgroups. Methods: This was a single-center, retrospective cohort study, conducted between August 1, 2016–July 1, 2021, of patients with medical cardiac arrest who were administered a known number of epinephrine doses. The primary outcome was neurologically intact discharge defined by a modified Rankin scale ≤3, with secondary outcomes of comparing epinephrine doses by age, rhythm, and emergency medical services vs emergency department administration of epinephrine. Results: The study included 1,330 patients, with 184 patients (13.8%) surviving to neurologically intact discharge. The primary outcome of neurologically intact discharge was found in 89 (65.4%) patients in the zero epinephrine dose group, 75 (20.0%) in the 1-3 dose group, 15 (4.3%) in the 4-6 dose group, and one (0.002%) in the ≥7 dose group (P < 0.001). Patients received similar amounts of epinephrine when stratified by age, while patients with shockable rhythms received more epinephrine than patients with non-shockable rhythms. Conclusion: There was a significant decrease in neurologically intact discharge with increasing number of epinephrine doses, and our data suggests that seven or more doses of epinephrine is almost always futile. While further prospective studies are needed, clinicians should consider epinephrine doses when weighing the futility or benefit of continued resuscitation efforts.https://escholarship.org/uc/item/656854c1 |
| spellingShingle | Zachary Boivin Kevin M. Duignan Donias Doko Nicholas Pugliese Trent She Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation Western Journal of Emergency Medicine |
| title | Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation |
| title_full | Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation |
| title_fullStr | Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation |
| title_full_unstemmed | Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation |
| title_short | Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation |
| title_sort | epinephrine in cardiac arrest identifying a potential limit for resuscitation |
| url | https://escholarship.org/uc/item/656854c1 |
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