Abstract
Background
Epinephrine is recommended for the treatment of non-shockable out of hospital cardiac
arrest (OHCA) to obtain return of spontaneous circulation (ROSC). Epinephrine efficiency
and safety remain under debate.
Objective
We propose to describe the association between the cumulative dose of epinephrine
and the failure of ROSC during the first 30 min of advanced life support (ALS).
Methodology
A retrospective observational cohort study using the Paris SAMU 75 registry including
all non-traumatic OHCA. All OHCA receiving epinephrine during the first 30 min of
ALS were enrolled. Cumulative epinephrine dose given during ALS to ROSC was retrieved
from medical reports.
Results
Among 1532 patients with OHCA, 776 (51%) had initial non-shockable rhythm. Fifty-four
patients were excluded for missing data.
The mean value of cumulative dose of epinephrine was 10 ± 4 mg in patients who failed
to achieve ROSC (ROSC−) and 4 ± 3 mg (p = 0.04) for those who achieved ROSC.
ROC curve analysis indicated a cut-off point of 7 mg total cumulative epinephrine
associated with ROSC− (AUC = 0.89 [0.86–0.92]).
Using propensity score analysis including age, sex and no-flow duration, association
with ROSC− only remained significant for epinephrine > 7 mg (p ≤10–3, OR [CI95] = 1.53 [1.42–1.65]).
Conclusion
An association between total cumulative epinephrine dose administered during OHCA
resuscitation and ROSC− was reported with a threshold of 7 mg, best identifying patients
with refractory OHCA. We suggest using this threshold in this context to guide the
termination of ALS and early decide on the implementation of extracorporeal life support
or organ harvesting in the first 30 min of ALS.
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Article Info
Publication History
Published online: May 25, 2018
Accepted:
May 24,
2018
Received in revised form:
May 20,
2018
Received:
February 28,
2018
Footnotes
☆The authors declare no competing interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
