TY - JOUR
T1 - Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest
T2 - A retrospective review of prospectively collected data
AU - Warren, Sam A.
AU - Huszti, Ella
AU - Bradley, Steven M.
AU - Chan, Paul S.
AU - Bryson, Chris L.
AU - Fitzpatrick, Annette L.
AU - Nichol, Graham
N1 - Funding Information:
Data acquisition was funded by Get With The Guidelines-Resuscitation which is supported by the American Heart Association and membership fees paid by participating hospitals. The remainder of the study was funded by a Fellowship training grant from Department of Health and Human Services, Public Health Services , Grant Type 6, Activity T32, ID Serial No. HP10002-21-00, Principal Investigator: Paula Lozano, MD, MPH.
Funding Information:
Research Grants: † Resuscitation Outcomes Consortium (NIH U01 HL077863-05) 2004–2015; Co-PI † Evaluation of Video Self-Instruction in Compressions-Only CPR (Asmund S. Laerdal Foundation for Acute Medicine) 2007–2011; PI † Randomized Trial of Hemofiltration After Resuscitation from Cardiac Arrest (NIH NHLBI R21 HL093641-01A1) 2009–2013; PI † Randomized Field Trial of Cold Saline IV After Resuscitation from Cardiac Arrest (NIH NHLBI R01 HL089554-03) 2007–2012; Co-I † Novel Methods of Measuring Health Disparities (NIH 1RC2HL101759-01) 2009–2011; Co-I † Cascade HeartRescue Project (Medtronic Foundation) 2010–2015; PI.
PY - 2014/3
Y1 - 2014/3
N2 - Background and aim: 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. Conclusion: Less frequent average epinephrine dosing than recommended by consensus guidelines was associated with improved survival of in-hospital cardiac arrest.
AB - Background and aim: 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. Conclusion: Less frequent average epinephrine dosing than recommended by consensus guidelines was associated with improved survival of in-hospital cardiac arrest.
KW - Arrhythmia
KW - Cardiopulmonary resuscitation
KW - Heart arrest
KW - Pharmacology
UR - http://www.scopus.com/inward/record.url?scp=84893971476&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2013.10.004
DO - 10.1016/j.resuscitation.2013.10.004
M3 - Article
C2 - 24252225
AN - SCOPUS:84893971476
SN - 0300-9572
VL - 85
SP - 350
EP - 358
JO - Resuscitation
JF - Resuscitation
IS - 3
ER -