Erythropoietin facilitates the return of spontaneous circulation and survival in victims of out-of-hospital cardiac arrest.
BACKGROUND
Erythropoietin activates potent protective mechanisms in non-hematopoietic tissues including the myocardium. In a rat model of ventricular fibrillation, erythropoietin preserved myocardial compliance enabling hemodynamically more effective CPR.


OBJECTIVE
To investigate whether intravenous erythropoietin given within 2 min of physician-led CPR improves outcome from out-of-hospital cardiac arrest.


METHODS
Erythropoietin (90,000 IU of beta-epoetin, n=24) was compared prospectively with 0.9% NaCl (concurrent controls=30) and retrospectively with a preceding group treated with similar protocol (matched controls=48).


RESULTS
Compared with concurrent controls, the erythropoietin group had higher rates of ICU admission (92% vs 50%, p=0.004), return of spontaneous circulation (ROSC) (92% vs 53%, p=0.006), 24-h survival (83% vs 47%, p=0.008), and hospital survival (54% vs 20%, p=0.011). However, after adjusting for pretreatment covariates only ICU admission and ROSC remained statistically significant. Compared with matched controls, the erythropoietin group had higher rates of ICU admission (92% vs 65%, p=0.024) and 24-h survival (83% vs 52%, p=0.014) with statistically insignificant higher ROSC (92% vs 71%, p=0.060) and hospital survival (54% vs 31%, p=0.063). However, after adjusting for pretreatment covariates all four outcomes were statistically significant. End-tidal PCO(2) (an estimate of blood flow during chest compression) was higher in the erythropoietin group.


CONCLUSIONS
Erythropoietin given during CPR facilitates ROSC, ICU admission, 24-h survival, and hospital survival. This effect was consistent with myocardial protection leading to hemodynamically more effective CPR (Trial registration: http://isrctn.org. Identifier: ISRCTN67856342).
Grmec
Stefek
S
Center for Emergency Medicine Maribor, Health Center Maribor, Slovenia.
Strnad
Matej
M
Kupnik
Dejan
D
Sinkovic
Andreja
A
Gazmuri
Raúl J
RJ
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003326:Coronary Circulation / Q000187:drug effects*; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006321:Heart / Q000187:drug effects*; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D004921:Erythropoietin; D012965:Sodium Chloride