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How Epinephrine affects cardiac arrest survival

Mar
24

Date: March 24th, 2015

Epinephrine is essentially an adrenaline that is administered to cardiac arrest patients before arriving at the hospital. It’s administration should definitely be part of first aid certification training for paramedics. It has come to be linked with reduced chances of survival and has no substantial mental disability as far as the results of an observational study are concerned. For those people who recovered spontaneous circulation instantly, only 17 percent of those who got Epinephrine were able to survive up to a point of being discharged from the hospital with a Category 1 or 2 of cerebral performance. This is in comparison to just 60 percent of those who never received the drug.

Pure alpha- adrenergic drug

According to a propensity subanalysis matched with the score, surviving cardiac arrest with a relatively good neurologic outcome continued to be less common for the group that received Epinephrine. Adjusted odds ratio of the same revealed that there was a risk dependent with the dose for the group that never got Epinephrine.

  • 0.48 for 1 Epinephrine mg with 95 percent confidence interval, i.e. 0.27- 0.84
  • 0.3 for between 2 and 5 mg of Epinephrine with 95 percent CI, i.e. 0.20 – 0.47
  • 0.23 for over 5 mg of Epinephrine with 95 percent CI, i.e. 0.14 – 0.37

The release of these findings comes at a time when there has been increased evidence that has been questioning the actual role that the guideline- recommended vasopressor administered for cardiac arrest out of hospital. According to the lead researcher, the main reason explaining this could be linked to timing or simply due to the fact that the adrenaline isn’t capable of getting the job done in the best way possible.

In a recent animal research, it was seen that when ventricular fibrillation arrest was in the circulatory phase, additional of a better adrenergic blocked could offer some help unlike when pure alpha- adrenergic drug is added like methoxamine or phenylephrine which didn’t. There is need for further research both in humans and animal models to help in assessing if a combination of agents or just pure alpha agent could be much more superior and better than Epinephrine especially during the resuscitation phase.

Epinephrine timing

In the study, the researchers found that delayed administration of Epinephrine was associated with much worse outcomes for the patients who had been admitted in a Paris Hospital with a single but a large cardiac arrest. Out of the 1, 556 patients who were included in the study, only 73 percent of them had actually received Epinephrine. However, it is worth noting that the outcome of this wasn’t really as bad when compared to no Epinephrine particularly when administration of the adrenaline was done soon after the person suffered a cardiac arrest. According to these findings, the researchers noted that proper timing of Epinephrine is crucial to enhancing chances of survival of any person with out of hospital cardiac arrest.

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