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: 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.
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Authors | Florence Dumas, Wulfran Bougouin, Guillaume Geri, Lionel Lamhaut, Adrien Bougle, Fabrice Daviaud, Tristan Morichau-Beauchant, Julien Rosencher, Eloi Marijon, Pierre Carli, Xavier Jouven, Thomas D Rea, Alain Cariou |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 64
Issue 22
Pg. 2360-7
(Dec 09 2014)
ISSN: 1558-3597 [Electronic] United States |
PMID | 25465423
(Publication Type: Journal Article, Observational Study)
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Copyright | Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Cardiopulmonary Resuscitation
(adverse effects, methods)
- Cohort Studies
- Epinephrine
(adverse effects)
- Female
- Humans
- Male
- Middle Aged
- Out-of-Hospital Cardiac Arrest
(diagnosis, drug therapy, mortality)
- Survival Rate
(trends)
- Treatment Outcome
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