Secondary ventricular fibrillation or pulseless ventricular tachycardia during cardiac arrest and epinephrine dosing.
BACKGROUND
Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality.


OBJECTIVE
To examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not.


METHODS
Data were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls). Dosing of epinephrine during cardiac arrest and other variables were compared between cases and controls.


RESULTS
Of the 215 patients identified with an initial rhythm of pulseless electrical activity or asystole, 51 (23.7%) had a secondary ventricular fibrillation or ventricular tachycardia develop. Throughout the total duration of arrest, including periods of return of spontaneous circulation, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.4 minutes compared with 1 mg every 5 minutes in controls (P= .001). For the total duration of pulselessness, excluding periods of return of spontaneous circulation during the arrest, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.1 minutes versus 1 mg every 4.3 minutes in controls (P= .001).


CONCLUSIONS
More frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia.
Andrew D. Straznitskas is a pharmacist at Bellevue Hospital Center, New York, New York. Sylvia Wong is a pharmacist at Harborview Medical Center, University of Washington Medicine, Seattle, Washington. Nicole Kupchik is an independent clinical nurse specialist and staff nurse at Swedish Medical Center, Seattle, Washington. David Carlbom is director of the paramedic training program and an associate professor of medicine, pulmonary critical care at Harborview Medical Center, University of Washington Medicine. andrew.straznitskas@bellevue.nychhc.org.
Andrew D
AD
Straznitskas
Andrew D. Straznitskas is a pharmacist at Bellevue Hospital Center, New York, New York. Sylvia Wong is a pharmacist at Harborview Medical Center, University of Washington Medicine, Seattle, Washington. Nicole Kupchik is an independent clinical nurse specialist and staff nurse at Swedish Medical Center, Seattle, Washington. David Carlbom is director of the paramedic training program and an associate professor of medicine, pulmonary critical care at Harborview Medical Center, University of Washington Medicine.
Sylvia
S
Wong
Andrew D. Straznitskas is a pharmacist at Bellevue Hospital Center, New York, New York. Sylvia Wong is a pharmacist at Harborview Medical Center, University of Washington Medicine, Seattle, Washington. Nicole Kupchik is an independent clinical nurse specialist and staff nurse at Swedish Medical Center, Seattle, Washington. David Carlbom is director of the paramedic training program and an associate professor of medicine, pulmonary critical care at Harborview Medical Center, University of Washington Medicine.
Nicole
N
Kupchik
Andrew D. Straznitskas is a pharmacist at Bellevue Hospital Center, New York, New York. Sylvia Wong is a pharmacist at Harborview Medical Center, University of Washington Medicine, Seattle, Washington. Nicole Kupchik is an independent clinical nurse specialist and staff nurse at Swedish Medical Center, Seattle, Washington. David Carlbom is director of the paramedic training program and an associate professor of medicine, pulmonary critical care at Harborview Medical Center, University of Washington Medicine.
David
D
Carlbom
D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology*; D014693:Ventricular Fibrillation / Q000453:epidemiology*; D014861:Washington / Q000453:epidemiology
D001993:Bronchodilator Agents; D004837:Epinephrine