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Total Epinephrine Dose During Asystole and Pulseless and Electrical Activity Cardiac Arrests is Associated with Unfavorable Functional Outcome and Increased In-Hospital Mortality
Study Question: Do increasing cumulative doses of epinephrine correlate with unfavorable functional outcome and in-hospital mortality in patients with asystole or PEA who are successfully resuscitated?
Study Description: Retrospective cohort study of patients who presented to Vienna General Hospital after witnessed in- or out-of hospital asystole or PEA arrest who were successfully resuscitated. Total cumulative epinephrine dose was recorded. Patients were considered to have an unfavorable functional outcome if they did not achieve a Cerebral Performance Category (CPC) score of 1 or 2 during the observation period. To adjust for confounding, all available variables that could be associated with outcome were also collected and multivariable regression was performed.
Results: Nine hundred forty six patients were included in the study. The median dose of epinephrine was 2 mg. Patients receiving higher doses had significantly longer low flow times and higher in-hospital mortality (p<0.001). In both univariable and multivariable regression, increasing doses of epinephrine were associated with an increased risk of unfavorable functional outcome and in-hospital mortality. The multivariable regression model suggested that the influence of effect of epinephrine dose on outcome is independent of the length of cardiac arrest.
Conclusion(s): Two hypotheses may explain the results: 1) epinephrine is potent at resuscitating patients with severe organ hypoxia who subsequently die in the hospital or 2) epinephrine has deleterious effects in the post-resuscitation period. Based on the results, the authors concluded that the increasing cumulative dose of epinephrine is an independent risk factor for unfavorable functional outcome or in-hospital mortality.
Perspective: This is a hypothesis generating retrospective study. Based on the results researching different treatment strategies, epinephrine dosage limits, or adjunctive agents for asystole and PEA patients may be warranted.