title: Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data.
abstract: OBJECTIVE
  Expert guidelines for treatment of cardiac arrest recommend administration of adrenaline (epinephrine) every three to five minutes. However, the effects of different dosing periods of epinephrine remain unclear. We sought to evaluate the association between epinephrine average dosing period and survival to hospital discharge in adults with an in-hospital cardiac arrest (IHCA).
  
  
  METHODS
  We performed a retrospective review of prospectively collected data on 20,909 IHCA events from 505 hospitals participating in the Get With The Guidelines-Resuscitation (GWTG-R) quality improvement registry. Epinephrine average dosing period was defined as the time between the first epinephrine dose and the resuscitation endpoint, divided by the total number of epinephrine doses received subsequent to the first epinephrine dose. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models.
  
  
  RESULTS
  Compared to a referent epinephrine average dosing period of 4 to <5 min per dose, survival to hospital discharge was significantly higher in patients with the following epinephrine average dosing periods: for 6 to <7 min/dose, adjusted odds ratio [OR], 1.41 (95%CI: 1.12, 1.78); for 7 to <8 min/dose, adjusted OR, 1.30 (95%CI: 1.02, 1.65); for 8 to <9 min/dose, adjusted OR, 1.79 (95%CI: 1.38, 2.32); for 9 to <10 min/dose, adjusted OR, 2.17 (95%CI: 1.62, 2.92). This pattern was consistent for both shockable and non-shockable cardiac arrest rhythms.
  
  
  CONCLUSIONS
  Less frequent average epinephrine dosing than recommended by consensus guidelines was associated with improved survival of in-hospital cardiac arrest.
authors.affiliation: University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, United States; Department of Medicine, Seattle, WA, United States; Department of Epidemiology, Seattle, WA, United States. Electronic address: sawarren@u.washington.edu.
authors.forename: Sam A
authors.initials: SA
authors.lastname: Warren
authors.affiliation: University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, United States; Department of Medicine, Seattle, WA, United States.
authors.forename: Ella
authors.initials: E
authors.lastname: Huszti
authors.affiliation: Department of Medicine, Seattle, WA, United States; Health Services Research and Development Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: Saint Luke's Mid-America Heart and Vascular Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: Department of Medicine, Seattle, WA, United States; Health Services Research and Development Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.affiliation: Department of Epidemiology, Seattle, WA, United States; University of Washington, Collaborative Health Studies Coordinating Center, United States; University of Washington, Department of Global Health, Seattle, WA, United States.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Fitzpatrick
authors.affiliation: University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, United States; Department of Medicine, Seattle, WA, United States; Clinical Trial Center, Department of Biostatistics, Seattle, WA, United States.
authors.forename: Graham
authors.initials: G
authors.lastname: Nichol
mesh_terms: D000368:Aged; D003625:Data Collection; D004334:Drug Administration Schedule; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine
keywords: Arrhythmia; Cardiopulmonary resuscitation; Heart arrest; Pharmacology