The Effect of Epinephrine Administration on Return of Spontaneous Circulation and One-Month Mortality with Cardiopulmonary Arrest Patients

Mustafa Sabak; Behçet Al; Mehmet Murat Oktay; Suat Zengin; Mustafa Boğan; Hasan Gümüşboğa; Mehmet Mustafa Sunar; Şevki Hakan Eren; Özlem Bingöl; Tanyeli Güneyligil Kazaz

doi:10.5152/eurjther.2020.19124

Authors

Mustafa Sabak Clinic of Emergency, Nizip State Hospital, Gaziantep, Turkey
Behçet Al Department of Emergency, Gaziantep University, Gaziantep, Turkey
Mehmet Murat Oktay Hasan Kalyoncu University, Vocational High School, Gaziantep, Turkey
Suat Zengin Department of Emergency, Gaziantep University, Gaziantep, Turkey
Mustafa Boğan Department of Emergency, Düzce University, Düzce, Turkey
Hasan Gümüşboğa Clinic of Emergency, Şehitkamil State Hospital, Gaziantep, Turkey
Mehmet Mustafa Sunar Clinic of Emergency, Kilis State Hospital, Kilis, Turkey
Şevki Hakan Eren Department of Emergency, Gaziantep University, Gaziantep, Turkey
Özlem Bingöl Clinic of Emergency, Söke Fehime Faik Kocagöz State Hospital, Aydın, Turkey
Tanyeli Güneyligil Kazaz Department of Biostatistics, Gaziantep University, Gaziantep, Turkey

DOI:

https://doi.org/10.5152/eurjther.2020.19124

Keywords:

Cardiac arrest, cardiopulmonary resuscitation, epinephrine, in-emergency department, out-of-hospital

Abstract

Objective: The objective of this study is to determine the effect of epinephrine administration on the return of spontaneous circu-lation (ROSC) and one-month mortality in patients with cardiopulmonary arrest.
Methods: We conducted this study between August 1, 2016 and May 31, 2017. Importantly, we included the witnessed cases (≥18 years) of in-emergency department cardiopulmonary arrest (IEDCA) and out-of-hospital cardiopulmonary arrest (OHCA) in the study. We divided the patients into two groups: the adrenaline group (Group 1) and the non-adrenaline group (Group 2). Thereaf-ter, we investigated ROSC and one-month mortality in them.
Results: We included 183 patients (50.3% of males and 49.7% of females with a mean age of 64.2±16.8 years) in the study. The percentages of IEDCA and OHCA cases were 25.1% and 74.9%, respectively. Epinephrine was administered to 100 (54.6%) patients (Group 1). Among these patients, 15.9% (n=29) of the patients had shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) and 84.1% (n=154) of them had non-shockable rhythms (asystole, pulseless electrical activity) as the initial rhythm. ROSC and one-month mortality rate of these patients were 24% (n=44) and 72.8% (n=36), respectively. The one-month mortality rates of Group 1 (30% of patients had IEDCA and 70% of patients had OHCA) and Group 2 were 43.8% and 56.2%, respectively (p=0.0231). The ROSC and one-month mortality rates of Group 1 and Group 2 cases, whose initial rhythm was a shockable rhythm, were 26.6% and 50% vs. 42.8% and 66.6%, respectively.
Conclusion: In this study, we found no significant difference in terms of obtaining ROSC between the shockable rhythm and ROSC in the IEDCA and OHCA cases (p=0.963 and p=0.141, respectively). The effect of epinephrine administration on patients with IED-CA and OHCA whose ROSC was obtained on one-month mortality was not statistically significant (p>0.05).

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References

Cardiac Arrest Registry to Enhance Survival. ''2017 Annual Report''. Available at https://mycares.net/sitepages/up-loads/2018/2017flipbook/index.html?page=16.Accessed December 18, 2018.

Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statis-tics-2018 update: a report from the American Heart Associa-tion. Circulation 2018; 137: e67-e492.

Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resusci-tation 2014; 85: 987-92.

Schluep M, Gravesteijn BY, Stolker RJ, Endeman H, Hoeks SE, et at. One-year survival after in-hospital cardiac arrest: A sys-tematic review and meta-analysis. Resuscitation 2018; 132: 90- 100.

American Heart Association '' 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emer-gency Cardiovascular Care''. Available at https://eccguidelines. heart.org/wp-content/uploads/2015/10/2015-AHA,Guidelines Highlights-English.pdf. Accessed December 18, 2018.

Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European resuscitation council guidelines for resuscitation 2015: section 3. Adult advanced life support. Resuscitation 2015; 95: 100-47.

Ristagno G, Tang W, Huang L, Fymat A, Chang YT, Sun S, et al. Epinephrine reduces cerebral perfusion during cardiopulmo-nary resuscitation. Crit Care Med 2009; 37: 1408-15.

Turkish Statistical Institute. ''Life Table 2014-16''. Available at http://www.tuik.gov.tr/PreHaberBultenleri.do?id=24640. Accessed October 23, 2018.

Turkish Statistical Institute. ''Death Statistics, 2017 ''. Available at http://www.tuik.gov.tr/PreHaberBultenleri.do?id=27620. Accessed October 23, 2018.

Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med 2018; 379: 711-21.

Koscik C, Pinawin A, McGovern H, Allen D, Media DE, Fergu-son T, et al. Rapid epinephrine administration improves ear-ly outcomes in out-of-hospital cardiac arrest. Resuscitation 2013; 84: 915-20.

Boyce LW, Vlieland TV, Bosch J, Wolterbeek R, Volker G, Exel HJV, et al. High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival. Neth Heart J 2015; 23: 20-5.

Oğuztürk H, Turtay MG, Tekin YK, et al. Cardiac Arrests in the Emergency Ward and Our Experiences on the Cardiopulmo-nary Resuscitation. Kafkas J Med Sci 2011; 1: 114-7.

Hirlekar G, Jonsson M, Karlsson T, Hollenberg J, Albertsson P, Herlitz J. Comorbidity and survival in out-of-hospital cardiac arrest. Resuscitation 2018; 133: 118-23.

Hirlekar G, Karlsson T, Aune S, Ravn-Fischer A, Albertsson P, Herlitz J, et al. Survival and neurological outcome in the elderly after in-hospital cardiac arrest. Resuscitation 2017; 118: 101-6.

Rueb GR, Brady WJ, Gilliland CA, Patrie JT, Saad WE, Sabri SS, et al. Characterizing cardiopulmonary arrest during inter-ventional radiology procedures. J Vasc Interv Radiol 2013; 24: 1774-8.

Kim YJ, Lee YJ, Ryoo SK, Sohn CH, Ahn S, Seo DW, et al. Role of blood gas analysis during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients. Medicine 2016; 95: e3960.

Von Auenmueller KI, Christ M, Sasko BM, Trappe HJ. The val-ue of arterial blood gas parameters for prediction of mor-tality in survivors of out-of-hospital cardiac arrest. J Emerg Trauma Shock 2017; 10: 134-9.

Dadeh AA, Nuanjaroan B. Using initial serum lactate level in the emergency department to predict the sustained return of spontaneous circulation in nontraumatic out-of-hospital cardiac arrest patients. Open Access Emerg Med 2018; 10:105.

Kurz MC, Prince DK, Christenson J, Carlson J, Stub D, Cheskes S, et al. Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmo-nary arrest. Resuscitation 2016; 98: 35-40.

Hiltunen P, Jäntti H, Silfvast T, Kuisma M, Kurola J, FINNRE-SUSCI Prehospital study group. Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes. Scand J Trauma Resusc Emerg Med 2016; 24: 49.

McMullan J, Gerecht R, Bonomo J, Robb R, McNally B, Don-nely J, et al. Airway management and out-of-hospital cardi-ac arrest outcome in the CARES registry. Resuscitation 2014; 85: 617-22.

Funada A, Goto Y, Tada H, Shimojima M, Hayashi K, Kawashiri MA, et al. Effects of Prehospital Epinephrine Administration on Neurologically Intact Survival in Bystander-Witnessed Out-of-Hospital Cardiac Arrest Patients With Initial Non-Shock-able Rhythm: Based on Emergency Medical Service Response Time. Heart Vessels 2017; 33: 1525-33.

Hansen M, Schmicker RH, Newgard CD, Gruanu B, Scheuer-meyer F, Cheskes S, et al. Time to Epinephrine Administra-tion and Survival From Nonshockable Out-of-Hospital Cardi-ac Arrest Among Children and Adults. Circulation 2018; 137: 2032-40.

Ueta H. Is early epinephrine administration still effective when the response time takes longer? Resuscitation 2017; 118: e44.

Hayashi Y, Iwami T, Kitamura T, Nishiuchi T, Kajino K, Sakai T, et al. Impact of early intravenous epinephrine administra-tion on outcomes following out-of-hospital cardiac arrest. Circ J 2012; 76: 1639-45.

Khera R, Chan PS, Donnino M, Girotra S, American Heart Association’s Get With The Guidelines-Resuscitation Inves-tigators. Hospital Variation in Time to Epinephrine for Non-shockable In-Hospital Cardiac ArrestClinical Perspective. Circulation 2016; 134: 2105-14.

Fisk CA, Olsufka M, Yin L, McCoy AM, Latimer AJ, May-nard C, et al. Lower-dose epinephrine administration and out-of-hospital cardiac arrest outcomes. Resuscitation 2018; 124: 43-8.

Lin S, Callaway CW, Shah PS, Wagner JD, Beyene J, Ziegler CP, et al. Adrenaline for out-of-hospital cardiac arrest resuscita-tion: a systematic review and meta-analysis of randomized controlled trials. Resuscitation 2014; 85: 732-40.

Long B, Koyfman A. Emergency medicine myths: Epinephrine in cardiac arrest. The J Emerg Med 2017; 52: 809-14.

Shao H, Li CS. Epinephrine in Out-of-hospital Cardiac Ar-rest: Helpful or Harmful? Chin Med J (Engl) 2017; 130: 2112.

Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PT. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resusci-tation 2011; 82: 1138-43.

Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L. Intravenous drug administration during out-of-hospi-tal cardiac arrest: a randomized trial. Jama 2009; 302: 2222-9.

Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. Jama 2012; 307: 1161-8.

Nakahara S, Tomio J, Nishida M, Morimura N, Ichikawa M, Sakamoto T. Association between timing of epinephrine administration and intact neurologic survival following out‐of‐hospital cardiac arrest in Japan: a population‐based prospective observational study. Acad Emerg Med 2012; 19: 782- 92.

Tomio J, Nakahara S, Takahashi H, Ichikawa M, Nishida M, Morimura N, et al. Effectiveness of prehospital epineph-rine administration in improving long-term outcomes of witnessed out-of-hospital cardiac arrest patients with ini-tial non-shockable rhythms. Prehosp Emerg Care 2017; 21: 432- 41.

Nakahara S, Tomio J, Takahashi H, Ichikawa M, Nishida M, Morimura N, et al. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest. BMJ 2013; 347: f6829.

Goto Y, Maeda T, Goto YN. Effects of prehospital epinephrine during out-of-hospital cardiac arrest with initial non-shock-able rhythm: an observational cohort study. Crit Care 2013; 17: R188.