Total epinephrine dose during resuscitation is associated with unfavorable functional outcome after cardiac arrest with asystole and pulseless electric activity in humans

Abstract

Purpose of the study: 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. Our objective was to investigate the association between the cumulative dose of epinephrine applied during resuscitation and in-hospital mortality and functional outcome, in patients with asystole and pulseless electric activity.Materials and methods: This retrospective cohort study is based on a cardiac arrest registry of the emergency department at the Vienna General Hospital/Medical University of Vienna. It comprises 946 patients admitted to the emergency department after resuscitation of witnessed cardiac arrest with asystole or pulseless electric activity. Data were documented according to Utstein Style. The risk factor was cumulative epinephrine categorized into quartiles. The endpoints were in-hospital mortality and unfavorable functional outcome.Results: The median cumulative amount of epinephrine administered was 2 mg (IQR 0–5), ranging from 1 to 50 mg. Of all patients 649 (69%) died during hospital stay, 643 (69%) had an unfavorable functional outcome. The multivariate analysis showed a statistically significant increasing risk for in-hospital mortality and unfavorable functional outcome with increasing cumulative doses of epinephrine (in hospital mortality: OR 1–1.54–2.73–4.42 over quartiles of epinephrine; unfavorable functional outcome: OR 1–1.8–3.66–6.45 over quartiles of epinephrine).Conclusion: Our results show that an increasing cumulative dose of epinephrine during resuscitation of patients with asystole and pulseless electric activity is an independent risk factor for in-hospital death and unfavorable functional outcome. Purpose of the study: 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. Our objective was to investigate the association between the cumulative dose of epinephrine applied during resuscitation and in-hospital mortality and functional outcome, in patients with asystole and pulseless electric activity. Materials and methods: This retrospective cohort study is based on a cardiac arrest registry of the emergency department at the Vienna General Hospital/Medical University of Vienna. It comprises 946 patients admitted to the emergency department after resuscitation of witnessed cardiac arrest with asystole or pulseless electric activity. Data were documented according to Utstein Style. The risk factor was cumulative epinephrine categorized into quartiles. The endpoints were in-hospital mortality and unfavorable functional outcome. Results: The median cumulative amount of epinephrine administered was 2 mg (IQR 0–5), ranging from 1 to 50 mg. Of all patients 649 (69%) died during hospital stay, 643 (69%) had an unfavorable functional outcome. The multivariate analysis showed a statistically significant increasing risk for in-hospital mortality and unfavorable functional outcome with increasing cumulative doses of epinephrine (in hospital mortality: OR 1–1.54–2.73–4.42 over quartiles of epinephrine; unfavorable functional outcome: OR 1–1.8–3.66–6.45 over quartiles of epinephrine). Conclusion: Our results show that an increasing cumulative dose of epinephrine during resuscitation of patients with asystole and pulseless electric activity is an independent risk factor for in-hospital death and unfavorable functional outcome.