Impact of adrenaline dose and timing on out-of-hospital cardiac arrest survival and neurological outcomes

Sigal, Adam; Sandel, Kristen; Buckler, David G; Wasser, Tom; Abella, Benjamin S.

doi:10.1016/j.resuscitation.2019.04.018

Cited by 33 publications

(25 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7 Although several studies have demonstrated that epinephrine is one of the most extensively used resuscitation drugs worldwide, [8][9][10] the outcomes for epinephrine injection in OHCA patients regarding neurological functions, reperfusion after the ROSC, and survival rate have been challenged by some recent reports. [11][12][13] Thus, the impact of dosage and timing of epinephrine administration on patient outcomes remains controversial. [13][14][15][16] An observational study showed that increasing the dose of epinephrine was an independent predictor of mortality and poor functional outcomes in patients with ventricular fibrillation cardiac arrest.…”

Section: Introductionmentioning

confidence: 99%

Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting

et al. 2019

View full text Add to dashboard Cite

Introduction Epinephrine is recommended for patients with out-of-hospital cardiac arrest (OHCA). However, whether epinephrine improves or adversely affects OHCA outcomes is controversial. Objectives This study aims to determine whether the frequency of epinephrine administration impacts OHCA patient survival. Methods We conducted a retrospective analysis of OHCA cases registered in the Emergency Department at King Fahd University Hospital, Saudi Arabia between 2005 and 2015. The primary outcomes were mortality and survival rates until discharge. The impact of epinephrine administration timing and frequency on patient survival was analyzed. Results Data from 300 OHCA cases were analyzed. Among them, 66.3% were men, and the overall mean age of 50.4 ± 20.6 years. The overall survival rate until hospital discharge was 12%. There was no statistically significant difference between in gender, age, or time interval to the first epinephrine dose in the survival and non-survival groups. Only the number of epinephrine doses was related to the survival outcome. Conclusion Non-survivors received significantly more epinephrine doses compared with survivors. However, a causal relationship between OHCA patient survival and epinephrine dose and time cannot be confirmed. Further studies are needed to investigate whether the long-term outcomes in OHCA patients are influenced by the timing and frequency of epinephrine administration.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Adrenaline is one of the few drugs incorporated in advanced life support algorithms [20]. The vasoconstriction effect is mediated by α-adrenergic receptors and promotes increased coronary blood flow, leading to increased probability of ROSC but has no impact in survival to hospital discharge [21][22][23][24]. Higher doses of adrenaline pre-ROSC associate with lower survival rate during hospital stay as they correlate directly with longer low-flow times [22,23].…”

Section: Prehospital Variablesmentioning

confidence: 99%

“…The vasoconstriction effect is mediated by α-adrenergic receptors and promotes increased coronary blood flow, leading to increased probability of ROSC but has no impact in survival to hospital discharge [21][22][23][24]. Higher doses of adrenaline pre-ROSC associate with lower survival rate during hospital stay as they correlate directly with longer low-flow times [22,23]. Furthermore, adrenaline was linked to ischemic lesions provoked by the vasoconstrictor effects on microvascular cerebral circulation and correlated to higher risk of poor neurological outcome [21,25].…”

Section: Prehospital Variablesmentioning

confidence: 99%

Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study

Trêpa

Bastos

Fontes-Oliveira

et al. 2020

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

IntroductionRecovered Out-of-Hospital Cardiac Arrest (rOHCA) population is heterogenous. Few studies focused on outcomes in the rOHCA subgroup with proven significant coronary artery disease (SigCAD). We aimed to characterize this subgroup and study the determinants of in-hospital mortality.MethodsRetrospective study of consecutive rOHCA patients submitted to coronary angiography. Only patients with SigCAD were included.Results60 patients were studied, 85% were male, mean age was 62.6 ± 12.1 years. In-hospital mortality rate was 43.3%. Patients with diabetes and history of stroke were less likely to survive. Significant univariate predictors of in-hospital mortality were further analysed separately, according to whether they were present at hospital admission or developed during hospital evolution. At hospital admission, initial non-shockable rhythm, low-flow time>12min, pH<7.25mmol/L and lactates >4.75mmol/L were the most relevant predictors and therefore included in a score tested by Kaplan-Meyer. Patients who had 0/4 criteria had 100% chance of survival till hospital discharge, 1/4 had 77%, 2/4 had 50%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. During in-hospital evolution, a pH<7.35 at 24h, lactates>2mmol/L at 24h, anoxic brain injury and persistent hemodynamic instability proved significant. Patients who had 0/4 of these in-hospital criteria had 100% chance of survival till hospital discharge, 1/4 had 94%, 2/4 had 47%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. Contrarily, CAD severity and ventricular dysfunction didn’t significantly correlate to the outcome.ConclusionClassic prehospital variables retain their value in predicting mortality in the specific group of OHCA with SigCAD. In-hospital evolution variables proved to add value in mortality prediction. Combining these simple variables in risk scores might help refining prognostic prediction in these patients’s subset.

show abstract

“…[9] Various trials suggest a time-dependent effect of Epinephrine on outcomes of CPR; earlier administration of intravenous Epinephrine may improve outcomes. [10,11] However, previous studies have shown delays in the administration of epinephrine are common in clinical practice, and thus found to be associated with worse outcomes in both adults and children. [12,13] A study in 2014 showed that earlier administration of epinephrine in patients with non-shockable cardiac arrest rhythms are associated with increased ROSC and survival.…”

Section: Introductionmentioning

confidence: 99%

Immediate Intravenous Epinephrine Versus Early Intravenous Epinephrine for In-Hospital Cardiopulmonary Arrest

Bakhsh

Safhi

Alghamdi

et al. 2021

Preprint

View full text Add to dashboard Cite

Background intravenous epinephrine has been a key treatment for cardiopulmonary arrest since the early 1960s. Although, many studies have questioned neurological outcome benefit, it remains to be recommended in international guidelines for its benefit on return of spontaneous circulation (ROSC). The ideal timing for the first epinephrine dose is uncertain. We aimed to look at the association of immediate epinephrine administration (within 1-minute of cardiac arrest recognition) with return of spontaneous circulation (ROSC) up to 24-hours and beyond 24-hours. Methods this was a multicenter retrospective chart review of patients undergoing cardiopulmonary resuscitation. Descriptive statistics were used to characterize study population, while t-test and chi-square were used to compare groups and outcomes. Results immediate epinephrine administration (within 1-minute) is associated with higher rates of ROSC up to 24-hours (OR = 2.36, 95% CI; [1.46–3.81]) and beyond 24-hours (OR = 2.26, 95% CI; [1.06–4.83]). Conclusions we encourage immediate administration of epinephrine in conjunction with high-quality CPR, as this is associated with higher rates of ROSC.

show abstract

Impact of adrenaline dose and timing on out-of-hospital cardiac arrest survival and neurological outcomes

Cited by 33 publications

References 18 publications

Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting

Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting

Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study

Immediate Intravenous Epinephrine Versus Early Intravenous Epinephrine for In-Hospital Cardiopulmonary Arrest

Contact Info

Product

Resources

About