Florence Dumas1, Wulfran Bougouin2, Guillaume Geri2, Lionel Lamhaut3, Adrien Bougle4, Fabrice Daviaud4, Tristan Morichau-Beauchant4, Julien Rosencher5, Eloi Marijon6, Pierre Carli7, Xavier Jouven6, Thomas D Rea8, Alain Cariou2. 1. INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris Descartes University, Paris, France. Electronic address: florence.dumas@cch.aphp.fr. 2. INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France; Medical Intensive Care Unit, Cochin Hospital, APHP, Paris Descartes University, Paris, France. 3. INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France; Emergency Medical Services, SAMU 75, Necker Hospital, APHP, Paris, France. 4. Medical Intensive Care Unit, Cochin Hospital, APHP, Paris Descartes University, Paris, France. 5. Department of Cardiology, Cochin Hospital, APHP, Paris Descartes University, Paris, France. 6. INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France. 7. Emergency Medical Services, SAMU 75, Necker Hospital, APHP, Paris, France. 8. Emergency Medical Services, Division of Public Health for Seattle and King County, University of Washington, Seattle, Washington.
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: This study sought to investigate the relationship between pre-hospital use of epinephrine and functional survival among patients with out-of-hospital cardiac arrest (OHCA) who achieved successful ROSC. 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.
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: This study sought to investigate the relationship between pre-hospital use of epinephrine and functional survival among patients with out-of-hospital cardiac arrest (OHCA) who achieved successful ROSC. 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.
Authors: Tara M Neumayr; Jeff Gill; Julie C Fitzgerald; Avihu Z Gazit; Jose A Pineda; Robert A Berg; J Michael Dean; Frank W Moler; Allan Doctor Journal: Pediatr Crit Care Med Date: 2017-10 Impact factor: 3.624
Authors: Jerry P Nolan; Robert A Berg; Clifton W Callaway; Laurie J Morrison; Vinay Nadkarni; Gavin D Perkins; Claudio Sandroni; Markus B Skrifvars; Jasmeet Soar; Kjetil Sunde; Alain Cariou Journal: Intensive Care Med Date: 2018-06-02 Impact factor: 17.440
Authors: Alessandro Putzu; Silvia Valtorta; Giuseppe Di Grigoli; Matthias Haenggi; Sara Belloli; Antonio Malgaroli; Marco Gemma; Giovanni Landoni; Luigi Beretta; Rosa Maria Moresco Journal: Neurocrit Care Date: 2018-06 Impact factor: 3.210