RSS Feeds
Cumulative Epinephrine Dose during Cardiopulmonary Resuscitation and Neurologic Outcome
- Wilhelm Behringer, MD;
- Harald Kittler, MD;
- Fritz Sterz, MD;
- Hans Domanovits, MD;
- Waltraud Schoerkhuber, MD;
- Michael Holzer, MD;
- Marcus Mullner, MD; and
- Anton N. Laggner, MD
- From University of Vienna Medical School, Vienna, Austria Grant Support: Dr. Behringer is supported by the Ministry of Science, Transport and the Arts (BMWVK), Austria (GZ 5.550/12 −Pr/4/95). Dr. Schoerkhuber is supported by the Fonds zur Foerderung der wissenschaftlichen Forschung (Austrian Science Foundation; P11405-MED). Dr. Holzer is supported by BIOMED2 European Commission, DG XII for Science Research and Development, Directorate Life Science and Technologies, Biomedical and Health Research Division (BMH4-CT96-0667). Requests for Reprints: Fritz Sterz, MD, Vienna General Hospital, University Clinics, Department of Emergency Medicine, Waehringerguertel 18-20/6/D, 1090 Vienna, Austria. Current Author Addresses: Drs. Behringer, Kittler, Sterz, Domanovits, Schoerkhuber, Holzer, Mullner, and Laggner: Vienna General Hospital, Waehringerguertel 18-20, 1090 Vienna, Austria.
Abstract
Background: Epinephrine is the drug of choice in advanced cardiac life support, but it can have deleterious side effects after restoration of spontaneous circulation.
Objective: To investigate the association between the cumulative epinephrine dose used in advanced cardiac life support and neurologic outcome after cardiac arrest.
Design: Retrospective cohort study.
Setting: University hospital.
Patients: Adults admitted to the emergency department with witnessed, nontraumatic, normothermic ventricular fibrillation cardiac arrest and unsuccessful initial defibrillation.
Measurements: Functional neurologic outcome was regularly assessed by cerebral performance category (CPC) within 6 months after cardiac arrest. A CPC of 1 or 2 was defined as favorable recovery.
Results: Among 178 enrolled patients, the median cumulative epinephrine dose administered was 4 mg (range, 0 to 50 mg). In 151 patients (84%), spontaneous circulation was restored; 63 of these 151 patients (42%) had favorable neurologic recovery. Patients with an unfavorable CPC received a significantly higher cumulative dose of epinephrine than did patients with a favorable CPC (4 mg compared with 1 mg; P < 0.001). This finding persisted after stratification by duration of resuscitation. After possible cofounders were controlled for, the cumulative epinephrine dose remained an independent predictor of unfavorable neurologic outcome.
Conclusions: The results indicate that an increasing cumulative dose of epinephrine administered during resuscitation is independently associated with unfavorable neurologic outcome after ventricular fibrillation cardiac arrest.
- Copyright ©2004 by the American College of Physicians
Related Clinical Content
