title: Total epinephrine dose during asystole and pulseless electrical activity cardiac arrests is associated with unfavourable functional outcome and increased in-hospital mortality.
abstract: OBJECTIVE
  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 unfavourable 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 unfavourable functional outcome and in-hospital mortality, in patients with asystole and pulseless electric activity.
  
  
  METHODS
  Data on 946 patients admitted to the emergency department after resuscitation of witnessed in-hospital and out-of hospital cardiac arrest with asystole or pulseless electric activity were retrieved from the cardiac arrest registry of the emergency department at the Vienna General Hospital/Medical University of Vienna. Data were documented according to Utstein Style. The risk factor was cumulative epinephrine categorized into quartiles. The endpoints were unfavourable functional outcome and in-hospital mortality.
  
  
  RESULTS
  The median cumulative amount of epinephrine administered was 2mg (IQR 0-5), ranging from 1 to 50mg. Of all patients 643/946 (68%) had an unfavourable functional outcome, 649/946 (69%) died during hospital stay. The multivariable analysis showed a statistically significant increasing risk for unfavourable functional outcome and in-hospital mortality outcome with increasing cumulative doses of epinephrine (unfavourable functional outcome: OR 1-1.45-2.25-2.95 over quartiles of epinephrine; in hospital mortality: OR 1-1.35-2.15-2.82 over quartiles of epinephrine).
  
  
  CONCLUSIONS
  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 unfavourable functional outcome and in-hospital mortality.
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20/6D, 1090 Wien, Austria. jasmin.arrich@meduniwien.ac.at
authors.forename: Jasmin
authors.initials: J
authors.lastname: Arrich
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Harald
authors.initials: H
authors.lastname: Herkner
authors.forename: Christoph
authors.initials: C
authors.lastname: Testori
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Behringer
mesh_terms: D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D004837:Epinephrine