Cumulative epinephrine dose during cardiopulmonary resuscitation and neurologic outcome.
BACKGROUND
Epinephrine is the drug of choice in advanced cardiac life support, but it can have deleterious side effects after restoration of spontaneous circulation.


OBJECTIVE
To investigate the association between the cumulative epinephrine dose used in advanced cardiac life support and neurologic outcome after cardiac arrest.


METHODS
Retrospective cohort study.


METHODS
University hospital.


METHODS
Adults admitted to the emergency department with witnessed, nontraumatic, normothermic ventricular fibrillation cardiac arrest and unsuccessful initial defibrillation.


METHODS
Functional neurologic outcome was regularly assessed by cerebral performance category (CPC) within 6 months after cardiac arrest. A CPC of 1 or 2 was defined as favorable recovery.


RESULTS
Among 178 enrolled patients, the median cumulative epinephrine dose administered was 4 mg (range, 0 to 50 mg). In 151 patients (84%), spontaneous circulation was restored; 63 of these 151 patients (42%) had favorable neurologic recovery. Patients with an unfavorable CPC received a significantly higher cumulative dose of epinephrine than did patients with a favorable CPC (4 mg compared with 1 mg; P < 0.001). This finding persisted after stratification by duration of resuscitation. After possible cofounders were controlled for, the cumulative epinephrine dose remained an independent predictor of unfavorable neurologic outcome.


CONCLUSIONS
The results indicate that an increasing cumulative dose of epinephrine administered during resuscitation is independently associated with unfavorable neurologic outcome after ventricular fibrillation cardiac arrest.
Behringer
W
W
University of Vienna Medical School, Austria.
Kittler
H
H
Sterz
F
F
Domanovits
H
H
Schoerkhuber
W
W
Holzer
M
M
Müllner
M
M
Laggner
A N
AN
D000322:Adrenergic Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy
D000322:Adrenergic Agonists; D004837:Epinephrine