Colchicine demonstrated superior efficacy versus usual care for prevention of atrial fibrillation after cardiac surgery. Moreover, colchicine treatment was associated with shorter hospital stays. These benefits outweigh increased risk of adverse drug-related effects; although further work is needed to minimize gastrointestinal effects.
Background
Advanced Cardiovascular Life Support (ACLS) guidelines recommend intravenous (IV) and intraosseous (IO) epinephrine as a basic cornerstone in the resuscitation process. Data about the efficacy and safety of intracoronary (IC) epinephrine during cardiac arrest in the catheterization laboratory is lacking.
Objective
To examine the efficacy and safety of IC versus IV epinephrine for resuscitation during cardiac arrest in the catheterization laboratory.
Methods
This is a prospective observational study that included all patients who experienced cardiac arrest in the Cath Lab at two tertiary centers in Egypt from January 2015 to July 2022. Patients were divided into two groups according to the route of epinephrine given; IC vs IV. The primary outcome was survival to hospital discharge. Secondary outcomes included rate of return of spontaneous circulation (ROSC), time-to-ROSC, and favorable neurological outcome at discharge defined as Modified Rankin Scale (MRS) <3.
Results
A total of 162 patients met our inclusion criteria, mean age (60.69 ± 9.61), 34.6% women. Fifty-two patients received IC epinephrine, and 110 received IV epinephrine as part of the resuscitation. Survival to hospital discharge was significantly higher in the IC epinephrine group (84.62% vs 53.64%, P < 0.001] compared with the IV epinephrine group. The rate of ROSC was higher in the IC epinephrine group (94.23% vs 70%, P < 0.001), and achieved in a shorter time (2.6 ± 1.97 minutes vs 6.8 ± 2.11 minutes, P < 0.0001) compared with the IV group. Similarly, favorable neurological outcomes were more common in the IC epinephrine group (76.92% vs 47.27%, P < 0.001] compared to the IV epinephrine group.
Conclusion
In this observational study, IC epinephrine during cardiac arrest in the Cath Lab appeared to be safe and may be associated with improved outcomes compared with the IV route. Larger randomized studies are encouraged to confirm these results.
Our findings provide a benchmark for current and future analyses relating to effectiveness of colchicine on POAF events after cardiac surgery. Currently, there are few reports that provide cutting edge estimates of the higher expenses associated with POAF. Future analyses should likewise explore the impact of added costs from using pharmacologic efforts to prevent and treat POAF after cardiac surgery.
Background: No-reflow is considered a major percutaneous coronary intervention complication, especially in primary PCI. A variety of medications have been studied for no-reflow treatment, including intracoronary nitrates, verapamil, adenosine, glycoprotein IIb/IIIa inhibitors, and epinephrine. Glycoprotein IIb/IIIa inhibitors and epinephrine are the two most promising agents for the treatment of no-reflow. Aim of work: evaluating epinephrine and glycoprotein IIb/IIIa inhibitors efficacy in treating no-reflow through local distal intracoronary injection in comparison to traditional intracoronary administration in the guiding catheter. Subjects and methods: 30 patients undergoing PCI complicated by no-reflow phenomenon. Patients were randomized to either group I where they were treated by local distal intracoronary injection of GP IIb/IIIa inhibitor and epinephrine or to group II where they received the same medications via the traditional intracoronary injection. Primary outcomes were TIMI flow, corrected TIMI frame count and TMPG, and major adverse cardiac events within 48 hours was the secondary outcome. Results: Group I had significantly superior angiographic outcomes than group II. As regards TIMI II-III flow, 86.7% of patients achieved it in versus 53.3% in group II, CTFC was 8.2versus 9.9, and in group I, 80% of patients achieved TMPG II-III, compared to 46.7 % in group II. MACE was insignificantly different between both groups. Diabetes mellitus was found to be the only predictor to be negatively associated with TIMI flow. Conclusion: Distal coronary artery local injection of a combination of GP IIb/IIIa inhibitors and epinephrine achieved superior angiographic outcomes in the treatment of refractory no-reflow in comparison with traditional intracoronary administration of the same medications.
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