The Association of the Average Epinephrine Dosing Interval and Survival With Favorable Neurologic Status at Hospital Discharge in Out-of-Hospital Cardiac Arrest - 25/11/19
, Takahisa Kawano, MD, PhD d, Frank X. Scheuermeyer, MD, MHSc a, c, Ian Drennan, BSc, ACP e, Christopher B. Fordyce, MD, MSc b, Sean van Diepen, MD, MSc g, Joshua Reynolds, MD, MS h, Steve Lin, MDCM, MSc f, Jim Christenson, MD a, cAbstract |
Study objective |
For patients with out-of-hospital cardiac arrest, the recommended dosing interval of epinephrine is 3 to 5 minutes, but this recommendation is based on expert opinion without data to guide optimal management. We seek to evaluate the association between the average epinephrine dosing interval and patient outcomes.
Methods |
In a secondary analysis of the Resuscitation Outcomes Consortium continuous chest compression trial, we identified consecutive patients treated with greater than or equal to 2 doses of epinephrine. We defined average epinephrine dosing interval as resuscitation duration after the first dose of epinephrine divided by the total administered epinephrine, and categorized the dosing interval in minutes as less than 3, 3 to less than 4, 4 to less than 5, and greater than or equal to 5. We fit a logistic regression model to estimate the association of the average epinephrine dosing interval category with survival with favorable neurologic status (modified Rankin Scale score ≤3) at hospital discharge.
Results |
We included 15,909 patients (median age 68 years [interquartile range 56 to 80 years], 35% women, 13% public location, 46% bystander cardiopulmonary resuscitation, and 19% initial shockable rhythm). The median epinephrine dosing interval was 4.3 minutes (interquartile range 3.5 to 5.3 minutes). Survival with favorable neurologic status occurred in 4.7% of patients. Compared with the reference dosing interval of less than 3 minutes, longer epinephrine dosing intervals were associated with lower survival with favorable neurologic status: dosing interval 3 to less than 4 minutes, adjusted odds ratio 0.44 (95% confidence interval 0.32 to 0.60); 4 to less than 5 minutes, adjusted odds ratio 0.26 (95% confidence interval 0.18 to 0.36); and greater than or equal to 5 minutes, adjusted odds ratio 0.21 (95% confidence interval 0.15 to 0.30).
Conclusion |
In this out-of-hospital cardiac arrest series, a shorter average epinephrine dosing interval was associated with improved survival with favorable neurologic status.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 798 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Henry E. Wang, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
|
| Author contributions: BG conceived the study. JC supervised original data collection. All authors designed the investigation. TK performed the statistical analysis. BG drafted the article, and all authors contributed substantially to its revision. BG takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The BC Resuscitation Research Unit is supported by the Heart and Stroke Foundation, the Institute for Circulatory and Respiratory Health of the Canadian Institutes of Health Research, the Provincial Health Services Authority, and Providence Health Care. |
|
| Readers: click on the link to go directly to a survey in which you can provide 2MTNQ9D to Annals on this particular article. |
|
| A podcast for this article is available at www.annemergmed.com. |
Vol 74 - N° 6
P. 797-806 - décembre 2019 Retour au numéro
Article précédent
- Intubation by Emergency Physicians: How Often Is Enough?
- Benjamin T. Kerrey, Henry Wang
- Epinephrine in Out-of-Hospital Cardiac Arrest: What Is the Role of the Timing Interval?
- Nicholas M. Mohr, Brett Faine
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?