Abstract P153: The Cumulative Dose of Epinephrine During Cardiopulmonary Resuscitation Increases Mortality and Functional Outcome after Non-Ventricular Fibrillation Cardiac Arrest

Abstract

Background - Epinephrine is the drug of choice during advanced cardiac life support. The cumulative dose of epinephrine applied during resuscitation was shown to be independently associated with unfavorable outcome after ventricular fibrillation cardiac arrest in humans. We investigated the association between the cumulative dose of epinephrine applied during resuscitation and outcome after non-ventricular fibrillation cardiac arrest. Methods - Adults admitted to the University Hospital Emergency Department with witnessed, non-traumatic, normothermic, non-ventricular fibrillation cardiac arrest of cardiac or pulmonary origin were included. The primary endpoint was in-hospital mortality, the secondary endpoint was unfavorable functional outcome (best cerebral performance category within 6 months; CPC 1, normal, CPC 2, moderate disability; CPC 3, severe disability and not able to live independently; CPC 4, coma; CPC 5, dead or brain dead; CPC 3–5 considered as unfavorable). Results - Of 2716 enrolled patients 578 patients fulfilled the inclusion criteria. The median cumulative amount of epinephrine administered during resuscitation was 3 mg (IQR 2– 6), ranging from 1 to 50 mg. Of all patients, 390 (67%) died during their hospital stay, 310 (62%) showed an unfavorable functional outcome. Patients, who died during hospital stay, received a statistically higher cumulative dose of epinephrine than patients, who survived, median (IQR) 4 mg (2– 6) vs. 2 mg (2– 4), p<0.01. After controlling for possible confounders (patient characteristics, resuscitation factors, comorbidities), logistic regression analysis showed that higher doses of epinephrine were independently associated with an increased mortality (OR 1.3 per quartile administered epinephrine, 95% CI 1.07–1.65, p=0.01), and unfavorable functional outcome (OR 1.4 per quartile administered epinephrine, 95% CI 1.12–1.81, p=0.004). Conclusions -Our results indicate that an increasing cumulative dose of epinephrine during resuscitation independently increases the risk for in-hospital death and unfavorable functional outcome after non-ventricular fibrillation cardiac arrest. Further studies are needed to re-evaluate the use of epinephrine during resuscitation in humans.