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The relationship between the outcome of cardiopulmonary resuscitation and the dosage of epinephrine in emergency department |
Xu Sheng-yong, Zhu Hua-dong, Yu Xue-zhong |
Emergency Department, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China |
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Abstract Objective To study the relationship between the outcome of cardiopulmonary resuscitation(CPR) in emergency department and the cumulative dose of epinephrine. Methods A retrospective analysis was made in all patients undergoing CPR in the emergency department of Peking Union Medical College Hospital from January 1, 2008 to June 30, 2018. The gender, age, etiology, cumulative dose of epinephrine and outcome of CPR were counted. The outcome of CPR included whether there was a return of spontaneous circulation (ROSC), whether they survived to discharge, and whether they survived to discharge with good neurologic function,among which survival to discharge with good neurologic function was the primary outcome. We analyzed the correlation between the cumulative dose of epinephrine and the outcome of CPR. Results A total of 1391 patients were enrolled in the study when there were 4843 patients with cardiac arrest during the study period. 530 patients (38.1%) hada ROSC, only 49 patients (3.5%) survived to discharge, and 35 patients (2.5%) had good neurological survival. There was a significant correlation between the cumulative dose of epinephrine> 5 mg and the poor outcome of CPR. Conclusion Patients with CPR whose epinephrine accumulated more than 5 mg had significantly deviated outcomes, and the probability of good neurological survival to discharge was zero.
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Corresponding Authors:
Zhu Hua-dong, E-mail:huadongzhu@hotmail.com
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[1]Loomba RS, Nijhawan K, Aggarwal S, et al. Increased return of spontaneous circulation at the expense of neurologic outcomes: Is prehospital epinephrine for out-of-hospital cardiac arrest really worth it[J]. J Crit Care, 2015, 30(6): 1376-1381.
[2]Spiegel R, Radecki R. Epinephrine in Out-of-Hospital Cardiac Arrest: Saving Lives or Prolonging Death: February 2019 Annals of Emergency Medicine Journal Club[J]. Ann Emerg Med, 2019, 73(2): 206-207.
[3]Kempton H, Vlok R, Thang C, et al. Standard dose epinephrine versus placebo in out of hospital cardiac arrest: A systematic review and meta-analysis[J]. Am J Emerg Med, 2019, 37(3): 511-517.
[4]Perkins GD, Quinn T, Deakin CD, et al. Pre-hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drugadministration In Cardiac arrest (PARAMEDIC-2): Trial protocol[J]. Resuscitation, 2016, 108: 75-81.
[5]Foss MV. Cardiac arrest and adrenalin[J]. Lancet, 1964, 1(7331): 483-484.
[6]Evans ME, Chassee T. BET 2: Usefulness of epinephrine in out-of-hospital cardiac arrest[J]. Emerg Med J, 2016, 33(5): 367-368.
[7]Zhang ZP, Su X, Yang YC, et al. Cardiac arrest with coronary artery spasm: does the use of epinephrine during cardiopulmonary arrest exacerbate the spasm[J]. Am J Emerg Med, 2015, 33(3): 479.
[8]Deakin CD, Yang J, Nguyen R, et al. Effects of epinephrine on cerebral oxygenation during cardiopulmonary resuscitation: A prospective cohort study[J]. Resuscitation, 2016, 109: 138-144.
[9]Hardig BM, Rundgren M. Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: A randomised porcine study[J]. Resuscitation, 2016, 101: 77-83.
[10]Perkins GD, Ji C, Deakin CD, et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest[J]. N Engl J Med, 2018, 379(8): 711-721.
[11]Callaham M, Madsen CD, Barton CW, et al. A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest[J]. JAMA, 1992, 268(19): 2667-2672.
[12]Berg RA, Otto CW, Kern KB, et al. A randomized, blinded trial of high-dose epinephrine versus standard-dose epinephrine in a swine model of pediatric asphyxial cardiac arrest[J]. Crit Care Med, 1996, 24(10): 1695-1700.
[13]Perondi MB, Reis AG, Paiva EF, et al. A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest[J]. N Engl J Med, 2004, 350(17): 1722-1730.
[14]Andersen LW, Berg KM, Saindon BZ, et al. Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest[J]. JAMA, 2015, 314(8): 802-810.
[15]Patel KK, Spertus JA, Khariton Y, et al. Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest[J]. Circulation, 2018, 137(19): 2041-2051.
[16]Cairns CB, Niemann JT. Hemodynamic effects of repeated doses of epinephrine after prolonged cardiac arrest and CPR: preliminary observations in an animal model[J]. Resuscitation, 1998, 36(3): 181-185.
[17]Warren SA, Huszti E, Bradley SM, et al. Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data[J]. Resuscitation, 2014, 85(3): 350-358.
[18]赵梦龙, 郭凯, 张源波, 等. 心脏骤停自主循环恢复患者预后的多因素Cox生存分析[J].中国急救医学,2017,37(2):149-152.
[19]Jouffroy R, Saade A, Alexandre P, et al. Epinephrine administration in non-shockable out-of-hospital cardiac arrest[J]. Am J Emerg Med, 2019, 37(3): 387-390. |
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