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For Cardiac Arrest with Nonshockable Rhythm, Quicker Epinephrine Is Better — Physician’s First Watch

Medical News |
May 22, 2014

For Cardiac Arrest with Nonshockable Rhythm, Quicker Epinephrine Is Better

By Kelly Young

Delayed administration of epinephrine for patients with in-hosptial cardiac arrest is associated with increased mortality, according to a retrospective study in BMJ.

Using a resuscitation registry, researchers identified 25,000 inpatients who had a cardiac arrest with a nonshockable rhythm (e.g., asystole or pulseless electrical activity). Only 10% survived to discharge. Mortality increased in a stepwise fashion as the time to epinephrine administration increased. When epinephrine was administered 10 minutes or more after recognition of cardiac arrest, there was a reduced chance of survival to discharge (odds ratio, 0.63), compared with administration within 1 to 3 minutes. Quicker administration of epinephrine was also associated with increased chance of return of spontaneous circulation, 24-hour survival, and neurologically intact survival.

The authors conclude: "When a patient is not in a shockable rhythm, current standard of care focuses on cardiopulmonary resuscitation only... With such a large proportion of cardiac arrests being nonshockable rhythms, future quality metrics could conceivably focus on shortening the time to administration of epinephrine in these patients."

Reader Comments (3)

RICK ABBOTT Physician, Emergency Medicine

Does this study imply (compared to no epinephrine) more benefit to early administration, or less harm with early compared to late administration of epinephrine. Either interpretation seems tenable.

Doug Physician, Surgery, Specialized

Epinephrine every 3 minutes is already in the ACLS protocol no matter what rhythm as long as compressions are ongoing.

david mayer md Physician, Anesthesiology, cooley dickinson hospital

why is this required?

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