Epinephrine for prehospital cardiac arrest with non-shockable rhythm

Samuel J Stratton

doi:10.1186/cc13044

Abstract

Cardiopulmonary arrest research and guidelines have generally focused on the treatment and management of ventricular fibrillation and pulseless ventricular fibrillation (electrical shockable rhythms). Less investigation has been done on the subpopulation of cardiopulmonary arrest victims that present with non-shockable rhythms. In a new paper, Goto, Maeda, and Goto present evidence that early use of epinephrine for treatment is associated with better survival with functional outcome. While there is a lack of evidence to support epinephrine for management of cardiopulmonary arrest presenting with initial shockable rhythms (presumed primary cardiac origin), there is now evidence that epinephrine may potentially benefit those presenting with non-shockable cardiopulmonary arrest (presumed heterogeneous origins). Further research on non-shockable rhythm cardiopulmonary arrest is needed to understand the subpopulation and develop better treatment guidelines.

Highlights

Goto and colleagues [1] are to be congratulated for their contribution to the medical knowledge base regarding the efficacy of epinephrine in resuscitation of nonshockable rhythm cardiac arrest
Goto and co-authors found an association between improved survival and functional outcome and the use of epinephrine for treatment of cardiopulmonary arrest presenting in other than the rhythms of ventricular fibrillation or pulseless ventricular tachycardia, which can immediately be treated with electrical counter shock
Recognizing that cardiopulmonary arrest can be of primary cardiac origin and secondary to other acute conditions, many researchers limit their study populations to those with ventricular fibrillation and pulseless ventricular tachycardia in an effort to select subjects with high probability of primary cardiac origin arrest

Summary

Introduction

Goto and colleagues [1] are to be congratulated for their contribution to the medical knowledge base regarding the efficacy of epinephrine in resuscitation of nonshockable rhythm cardiac arrest. Hagihara and co-authors showed in a study published in 2012 [6] that the use of epinephrine for cardiopulmonary arrest was associated with return of spontaneous circulation but negatively was associated with decreased survival and functional outcome. Goto and co-authors found an association between improved survival and functional outcome and the use of epinephrine for treatment of cardiopulmonary arrest presenting in other than the rhythms of ventricular fibrillation or pulseless ventricular tachycardia, which can immediately be treated with electrical counter shock. The data presented by Goto and co-authors support the use of epinephrine for cardiopulmonary arrest presenting with non-shockable rhythms. This commentary explores the implications these findings have for future resuscitation and research

Discussion

Conclusion