Search
Background
The ACLS recommendation for epinephrine dosing in most cardiac arrest cases is 1 mg every 3-5 minutes. This dosing interval is largely based on expert opinion.
Primary Outcome
A new study reviewed 21,000 in-hospital cardiac arrest (IHCA) cases from the Get With the Guidelines-Resuscitation registry. The authors sought to examine the association between epinephrine dosing period and survival to hospital discharge in adults with an IHCA.
Methods
- For 6 to <7 min/dose, adjusted OR, 1.41 (95%CI: 1.12, 1.78)
- For 7 to <8 min/dose, adjusted OR, 1.30 (95%CI: 1.02, 1.65)
- For 8 to <9 min/dose, adjusted OR, 1.79 (95%CI: 1.38, 2.32)
- For 9 to<10 min/dose, adjusted OR, 2.17 (95%CI: 1.62, 2.92)
This pattern was consistent for both shockable and non-shockable cardiac arrest rhythms.
- This study only included in-hospital cardiac arrests.
- The data was retrospectively reviewed from a registry of prospectively collected data.
- This is certainly an interesting finding that needs to be explored further.
- Given that epinephrine in cardiac arrest has never been proven to work (and may cause harm), it's not too suprising that giving less of a potentially harmful drug portends better outcomes.
References
Warren SA, et al. Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: A retrospective review of prospectively collected data. Resuscitation 2014;85(3):350-8. [PMID 24252225]
Follow me on Twitter (@PharmERToxGuy) or Google Plus (+bryanhayes13)