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Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest.

Abstract：

STUDY OBJECTIVE:The benefit of epinephrine in cardiac arrest is controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) system that previously did not use intravenous medications. METHODS:This observational, prospective, before-after clinical study constitutes phase II of the Cardiac Arrest and Resuscitation Epidemiology project. Included were all patients who are older than 8 years, with nontraumatic out-of-hospital cardiac arrest conveyed by the national emergency ambulance service. The comparison between the 2 intervention groups for survival to discharge was made with logistic regression and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI). RESULTS:From October 1, 2002, to October 14, 2004, 1,296 patients were enrolled into the study, with 615 in the pre-epinephrine and 681 in the epinephrine phase. Demographic and EMS characteristics were similar in both groups. Forty-four percent of patients received intravenous epinephrine in the epinephrine phase. There was no significant difference in survival to discharge (pre-epinephrine 1.0%; epinephrine 1.6%; OR 1.7 [95% CI 0.6 to 4.5]; adjusted for rhythm OR 2.0 [95% CI 0.7 to 5.5]); return of circulation (pre-epinephrine 17.9%; epinephrine 15.7%; OR 0.9 [95% CI 0.6 to 1.2]), or survival to admission (pre-epinephrine 7.5%; epinephrine 7.5%; OR 1.0 [95% CI 0.7 to 1.5]). There was a minimal increase in scene time in the epinephrine phase (10.3 minutes versus 10.7 minutes; 95% CI of difference 0.02 to 0.94 minutes). CONCLUSION:We were unable to establish a significant survival benefit with the introduction of intravenous epinephrine to an EMS system. More research is needed to determine the effectiveness of drugs such as epinephrine in resuscitation.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Ong ME,Tan EH,Ng FS,Panchalingham A,Lim SH,Manning PG,Ong VY,Lim SH,Yap S,Tham LP,Ng KS,Venkataraman A,Cardiac Arrest and Resuscitation Epidemiology Study Group.

doi

10.1016/j.annemergmed.2007.03.028

subject

Has Abstract

pub_date

2007-12-01 00:00:00

pages

635-42

issue

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(07)00389-7

journal_volume

pub_type

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Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest.