Author + information
- Received May 28, 2014
- Revision received August 18, 2014
- Accepted September 4, 2014
- Published online December 9, 2014.
- Florence Dumas, MD, PhD∗,†∗ (, )
- Wulfran Bougouin, MD, MPH∗,‡,
- Guillaume Geri, MD, MSc∗,‡,
- Lionel Lamhaut, MD∗,§,
- Adrien Bougle, MD‡,
- Fabrice Daviaud, MD‡,
- Tristan Morichau-Beauchant, MD‡,
- Julien Rosencher, MD‖,
- Eloi Marijon, MD, PhD∗,
- Pierre Carli, MD, PhD§,
- Xavier Jouven, MD, PhD∗,
- Thomas D. Rea, MD, MPH¶ and
- Alain Cariou, MD, PhD∗,‡
- ∗INSERM U970, Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
- †Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris Descartes University, Paris, France
- ‡Medical Intensive Care Unit, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- §Emergency Medical Services, SAMU 75, Necker Hospital, APHP, Paris, France
- ‖Department of Cardiology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
- ¶Emergency Medical Services, Division of Public Health for Seattle and King County, University of Washington, Seattle, Washington
- ↵∗Reprint requests and correspondence:
Dr. Florence Dumas, INSERM U970, Parisian Cardiovascular Research Center, 56 rue Leblanc, 75015 Paris, France.
Background Although epinephrine is essential for successful return of spontaneous circulation (ROSC), the influence of this drug on recovery during the post–cardiac arrest phase is debatable.
Objectives This study sought to investigate the relationship between pre-hospital use of epinephrine and functional survival among patients with out-of-hospital cardiac arrest (OHCA) who achieved successful ROSC.
Methods We included all patients with OHCA who achieved successful ROSC admitted to a cardiac arrest center from January 2000 to August 2012. Use of epinephrine was coded as yes/no and by dose (none, 1 mg, 2 to 5 mg, >5 mg). A favorable discharge outcome was coded using a Cerebral Performance Category 1 or 2. Analyses incorporated multivariable logistic regression, propensity scoring, and matching methods.
Results Of the 1,556 eligible patients, 1,134 (73%) received epinephrine; 194 (17%) of these patients had a good outcome versus 255 of 422 patients (63%) in the nontreated group (p < 0.001). This adverse association of epinephrine was observed regardless of length of resuscitation or in-hospital interventions performed. Compared with patients who did not receive epinephrine, the adjusted odds ratio of intact survival was 0.48 (95% confidence interval [CI]: 0.27 to 0.84) for 1 mg of epinephrine, 0.30 (95% CI: 0.20 to 0.47) for 2 to 5 mg of epinephrine, and 0.23 (95% CI: 0.14 to 0.37) for >5 mg of epinephrine. Delayed administration of epinephrine was associated with worse outcome.
Conclusions In this large cohort of patients who achieved ROSC, pre-hospital use of epinephrine was consistently associated with a lower chance of survival, an association that showed a dose effect and persisted despite post-resuscitation interventions. These findings suggest that additional studies to determine if and how epinephrine may provide long-term functional survival benefit are needed.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2014.
- Revision received August 18, 2014.
- Accepted September 4, 2014.
- American College of Cardiology Foundation