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Previous studies have suggested that a single dose of epinephrine in out of hospital cardiac arrests compared to multiple dose protocols result in a similar survival to hospital discharge rate. This study aimed to see if single dose epinephrine compared to multiple doses improved survival in the subset of patients that were 1) in a shockable rhythm or 2) received bystander CPR.
This study looked at patients from 5 EMS systems in North Carolina before and after a protocol change from multiple dose epinephrine to single dose epinephrine in cardiac arrest. 1690 patients were included, 19.2% with a shockable rhythm and 38.9% who received bystander CPR.
The study found:
- Survival to hospital discharge was higher in the single dose epinephrine group who received bystander CPR
- Survival rates were similar in the single and multiple dose epinephrine groups for patients who were initially in shockable rhythms, in asystole/PEA and who did NOT receive bystander CPR.
Bottom Line: More studies are needed to support prehospital protocol changes.
References
George TS, Ashburn NP, Snavely AC, et al. Does Single Dose Epinephrine Improve Outcomes for Patients with Out-of-Hospital Cardiac Arrest and Bystander CPR or a Shockable Rhythm?. Prehosp Emerg Care. Published online May 21, 2024. doi:10.1080/10903127.2024.2348663