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Abstract

Introduction: Although randomized controlled trials have explored the use of epinephrine for out-of-hospital cardiac arrest patients, there remains a lack of research on the benefit and proper dose of epinephrine for in-hospital cardiac arrest patients. Past research has indicated that epinephrine might increase return of spontaneous circulation (ROSC), but has not been shown to significantly improve long-term outcomes. Further, it has been linked to post-resuscitation myocardial dysfunction and reduced cerebral microcirculation, which might be a contributing factor to anoxic brain injury. Therefore, conservative use of epinephrine for in-hospital cardiac arrest patients might increase the survival rate. Methods: I conducted a retrospective chart review to see whether the use of epinephrine affects 24 hour survival after in-hospital cardiac arrest. Clinical, demographic, and treatment data were collected and analyzed for 85 in-hospital cardiac arrest patients. Of these 85 patients, 70 had a non-VF cardiac arrest due to pulseless electrical activity (PEA) or asystole. The non-VF arrest group was divided into three groups: short-duration arrest group (defined by downtime of less than 10 minutes), intermediate-duration arrest group (defined by downtime of 10 to 20 minutes), and long-duration arrest group (defined by downtime of more than 20 minutes). Results: In the non-VF arrest group, 60 percent of patients (42/70) survived 24 hours after cardiopulmonary resuscitation (CPR) initiation. 76 percent of patients (32/42) who survived 24 hours received a low dose of epinephrine (0mg -2mg) as compared to 21 percent (6/28) in the non-survivor group (p–value= 0.0029). In the intermediate-duration arrest group, 71 percent of patients (10/14) who survived 24 hours received a low dose of epinephrine (0mg-2mg) as compared to 10 percent (1/10) in the non-survivor group (p–value=0.0045). In the long-duration arrest group, 50 percent of patients (5/10) who survived 24 hours received a low dose of epinephrine (0mg-2mg) as compared to 19 percent (3/16) in the non-survivor group (p–value=0.1892). Further, 63 percent of patients (15/24) who survived 24 hours in prolonged cardiac arrest (defined by downtime of more than 10 minutes) received a low dose of epinephrine as compared to 15 percent (4/26) in the non-survivor group (p–value=0.0011). Conclusions: The results suggest that the conservative use of epinephrine might be beneficial for in-hospital cardiac arrest patients due to PEA or asystole. Further studies are needed to verify this intriguing preliminary data with more subjects.