Cardiology CME: Epinephrine in Cardiac Arrest

A recent study out of Paris looked at a large number of out of hospital cardiac arrests that received epinephrine and had spontaneous return of circulation (ROSC).

In a propensity score-matched sub-analysis, survival with good neurologic outcome remained substantially less common in the epinephrine group (30% versus 61%, P<0.001), the researchers reported in the Dec. 9 issue of the Journal of the American College of Cardiology.

Those who had ROSC showed the following: ID-100276756

Those that received more epi had the worst outcome!

But, those that received epi within 9 minutes had a slightly better outcome.

What’s the difference? It is the timing of the epi?

We know early interventions in cardiac arrest are a good thing.  Early CPR works.  Early access to defibrillation works.  So, earlier use of epi would be logical and in concert with other efforts, such as CPR and defibrillation.

It will be interesting to see what changes will occur in the new 2015 ACLS protocols.

When epinephrine might not be the best choice.

If a patient is in cardiac arrest greater than nine minutes, evidence suggests backing away from epi.  Vasopressin may be the right choice.

I like epi due to its longer effective action. Also, I like epi because  it works better in an acidotic medium and it doesn’t stress the heart (beta receptor).

What is your take on this new research? Will it affect your use of epi?

Image courtesy of FreeDigitalPhotos.net/cooldesign 

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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.
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