Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients?
Key result
Pre-hospital epinephrine in OHCA linked to ~52% lower odds of intact neurologic survival.
- OR 0.48
- 95% CI 0.27-0.84
- P<0.001
- n=1,556
Why the study?
The influence of epinephrine on recovery during the post-cardiac arrest phase after successful ROSC in OHCA patients is debatable.
Does pre-hospital use of epinephrine improve functional survival in patients with out-of-hospital cardiac arrest who achieved successful ROSC?
Population
1,556 OHCA patients with successful ROSC admitted to a cardiac arrest center from 2000 to 2012
Comparison
Pre-hospital use of epinephrine (none, 1 mg, 2 to 5 mg, >5 mg) vs no epinephrine
Design
Cohort study
Follow-up
Until hospital discharge
Authors
Discussion
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Implication
Pre-hospital use of epinephrine in out-of-hospital cardiac arrest patients who achieve ROSC is associated with a dose-dependent decrease in the likelihood of intact functional survival at discharge.
Key Points
- To examine the association between pre-hospital epinephrine administration, including dose-response relationships, and functional survival among out-of-hospital cardiac arrest patients who achieved return of spontaneous circulation.
- Retrospective cohort of consecutive out-of-hospital cardiac arrest patients admitted with return of spontaneous circulation to a single cardiac arrest center between January 2000 and August 2012 (N=1,556).
- Pre-hospital epinephrine was categorized as yes/no and by cumulative dose: none, 1 mg, 2 to 5 mg, and >5 mg.
- Favorable functional outcome was defined as Cerebral Performance Category 1 or 2 at discharge, analyzed using multivariable logistic regression and propensity-score matching.
- Favorable neurological survival occurred in 17% (194/1,134) of epinephrine-treated patients compared to 63% (255/422) of untreated patients (p < 0.001).
- Intact survival showed a dose-dependent decrease relative to no epinephrine: adjusted OR 0.48 (95% CI: 0.27 to 0.84) for 1 mg, adjusted OR 0.30 (95% CI: 0.20 to 0.47) for 2 to 5 mg, and adjusted OR 0.23 (95% CI: 0.14 to 0.37) for >5 mg.
- The adverse association persisted irrespective of resuscitation duration or in-hospital therapies, and delayed administration was linked to poorer functional outcomes.
Study Design
Type
Cohort (n=1,556)
Structured PICO
Does pre-hospital use of epinephrine improve functional survival in patients with out-of-hospital cardiac arrest who achieved successful ROSC?
P
Population
1,556 patients with out-of-hospital cardiac arrest who achieved successful return of spontaneous circulation admitted to a cardiac arrest center.
E
Exposure
Pre-hospital use of epinephrine (evaluated by dose: 1 mg, 2 to 5 mg, >5 mg)
C
Comparator
No pre-hospital use of epinephrine
O
Outcome
Favorable discharge outcome (defined as Cerebral Performance Category 1 or 2)hard clinical
Main Result
Odds Ratio: 0.48 (95% CI 0.27–0.84)
Absolute Event Rate: 17% vs 63%
p-value: p=<0.001
Pre-hospital use of epinephrine in out-of-hospital cardiac arrest patients who achieve ROSC is associated with a dose-dependent decrease in the likelihood of intact functional survival at discharge.
Cite This Study
Dumas et al. (2014) conducted a cohort in Out-of-hospital cardiac arrest (OHCA) with successful ROSC (n=1,556). Pre-hospital use of epinephrine vs. No epinephrine was evaluated on Favorable discharge outcome (Cerebral Performance Category 1 or 2) (OR 0.48, 95% CI 0.27-0.84, p=<0.001). Pre-hospital use of epinephrine in OHCA patients achieving ROSC was associated with a lower chance of intact survival (17% vs 63% without epinephrine; P<0.001), with a dose-dependent effect.