Early Epinephrine Increases Survival Odds in Cardiac Arrest

Epinephrine administered early on will increase the likelihood of survival for cardiac arrest patients with non-shockable rhythms, according to a new retrospective analysis.

“For patients who are in cardiac arrest (no blood pressure/pulse = dead) and their electrocardiogram shows a ‘non-shockable’ rhythm (no indication for defibrillation), we found that if epinephrine is given earlier—then there is an associated statistically significant increased chance of survival. For each 3-minute interval that goes by without epinephrine, the associated chances of survival are decreased,” said lead author Michael Donnino, MD.
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Most previous studies targeted people with shockable rhythms.

In this study, researchers focused on 25,095 patients (57% male, 43% female) with a mean age of 72. All participants had in-hospital cardiac arrests with non-shockable rhythms.

Researchers noted a decrease in survival as the interval times—the median time of initial epinephrine dosage was 3 minutes—of epinephrine increased. The results were: interval 0.82 to 1.00; P=0.055) for 4-6 minutes; 0.74 (0.63 to 0.88; P<0.001) for 7-9 minutes; and 0.63 (0.52 to

0.76; P<0.001) for >9 minutes.

Donnino noted that the findings were associative, rather than causative, but that multiple statistical analyses were conducted to eliminate concern for cofounders.

“For patients who are going to receive epinephrine, epinephrine should be administered as soon possible. However, the important caveats are that we are not talking about patients with shockable rhythms or about patients who are not truly in cardiac arrest,” said Donnino.

–Pooja Shah

Reference:

Donnino M, Howell MD, Cocchi M, et al. Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ. 2014 May 20 [epub ahead of print] doi: 10.1136/bmj.g3028