After a century, Epinephrine's role in cardiac arrest resuscitation remains controversial

Bornstein, Kasha; Long, Brit; Porta, Alessandra Della; Weinberg, Guy

doi:10.1016/j.ajem.2020.08.103

Cited by 8 publications

(5 citation statements)

References 44 publications

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“…The current evidence demonstrates that epinephrine improves the rates of ROSC but is not associated with improvements in neurologic or long-term outcomes [ 6 ]. Previous studies in the pre-hospital setting have shown that epinephrine only improved the rate of pre-hospital ROSC in traumatic OHCA cases following traffic collisions compared with no pre-hospital epinephrine administration [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…To examine the relationship between outcomes and epinephrine timing, we evaluated epinephrine timing as a categorical variable in multivariable logistic regression models, and the adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Factors that were associated with clinical outcomes and biologically essential were included as potential confounders in multivariable analyses [ 4 , 5 , 6 , 7 , 8 , 9 ]. These variables included age (18–64, 65–74, ≥75 years), sex (male, female), witness status (none, witnessed by bystanders), first documented rhythm (VF/pVT, PEA, asystole), bystander CPR status (no CPR, any CPR), advanced airway management, (none, endotracheal intubation [ETI], supraglottic airway [SGA]), pre-hospital physician involvement, (i.e., bias from another ALS procedure such as insertion of chest tube, blood transfusion, resuscitative endovascular occlusion of the aorta, and thoracotomy), and year of the arrest.…”

Section: Methodsmentioning

confidence: 99%

“…Although epinephrine is one of the most widely used resuscitation drugs worldwide, the current literature suggests that epinephrine may only provide benefits in certain situations [ 6 ]. Its benefits and risks remain controversial in the context of trauma [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

Hosomi

Kitamura

Sobue

et al. 2022

JCM

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The effects of epinephrine administration timing on patients with out-of-hospital cardiac arrest (OHCA) following traffic collisions are unknown. We analyzed the 2013–2019 All-Japan Utstein Registry data of 2024 such patients aged ≥18 years who were resuscitated by emergency medical service (EMS) personnel or bystanders and then transported to medical institutions. Time from 119 call to epinephrine administration was classified into quartiles: Q1 (6–21 min), Q2 (22–26 min), Q3 (27–34 min), and Q4 (35–60 min). Multivariable logistic regression analysis was used to assess the effects of epinephrine administration timing on one-month survival after OHCA. Overall, the one-month survival rates were 3.2% (15/466) in Q1, 1.1% (5/472) in Q2, 1.9% (11/577) in Q3, and 0.2% (1/509) in Q4. Additionally, the one-month survival rate decreased significantly in the Q4 group (adjusted odds ratio, 0.07; 95% confidence interval, 0.01–0.57) compared with the Q1 group, and the probability of one-month survival decreased as the time from the EMS call to epinephrine administration increased (p-value for trend = 0.009). Only four patients (0.9% [4/466]) with the earliest epinephrine administration showed a good neurological outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

Hosomi

Kitamura

Sobue

et al. 2022

JCM

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“… 30 , 31 However, future studies need to investigate the effects of different epinephrine dosing regimens on CA outcome, especially considering the increased concerns of potentially detrimental effects of the epinephrine use during resuscitation on neurologic recovery. 32 Lastly, although we analyzed the post‐CA immune response in both young adult and aged mice, it must be noted that a short CA duration was applied to aged mice. Therefore, this critical difference should be considered when comparing the immune changes between young adult and aged mice.…”

Section: Discussionmentioning

confidence: 99%

Development and Evaluation of a Novel Mouse Model of Asphyxial Cardiac Arrest Revealed Severely Impaired Lymphopoiesis After Resuscitation

Wang

Miao

et al. 2021

JAHA

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Background Animal disease models represent the cornerstone in basic cardiac arrest (CA) research. However, current experimental models of CA and resuscitation in mice are limited. In this study, we aimed to develop a mouse model of asphyxial CA followed by cardiopulmonary resuscitation (CPR), and to characterize the immune response after asphyxial CA/CPR. Methods and Results CA was induced in mice by switching from an O 2 /N 2 mixture to 100% N 2 gas for mechanical ventilation under anesthesia. Real‐time measurements of blood pressure, brain tissue oxygen, cerebral blood flow, and ECG confirmed asphyxia and ensuing CA. After a defined CA period, mice were resuscitated with intravenous epinephrine administration and chest compression. We subjected young adult and aged mice to this model, and found that after CA/CPR, mice from both groups exhibited significant neurologic deficits compared with sham mice. Analysis of post‐CA brain confirmed neuroinflammation. Detailed characterization of the post‐CA immune response in the peripheral organs of both young adult and aged mice revealed that at the subacute phase following asphyxial CA/CPR, the immune system was markedly suppressed as manifested by drastic atrophy of the spleen and thymus, and profound lymphopenia. Finally, our data showed that post‐CA systemic lymphopenia was accompanied with impaired T and B lymphopoiesis in the thymus and bone marrow, respectively. Conclusions In this study, we established a novel validated asphyxial CA model in mice. Using this new model, we further demonstrated that asphyxial CA/CPR markedly affects both the nervous and immune systems, and notably impairs lymphopoiesis of T and B cells.

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“…Additionally, female rats of the same age had significantly lower body weight than males. The smaller size led to decreased dosages of pentobarbital and epinephrine, thus might provide benefit for resuscitation and neurological recovery [ 36 , 37 ]. Therefore, the pathologic or hormonal influence between males and females should be considered when evaluating neurological outcome and combining estrogen may potentiate the effectiveness of post resuscitation interventions.…”

Section: Discussionmentioning

confidence: 99%

Interaction between gender and post resuscitation interventions on neurological outcome in an asphyxial rat model of cardiac arrest

Wang

Chen

et al. 2021

BMC Cardiovasc Disord

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Purpose Previous clinical studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest, but the results are conflicting and there is no uniform agreement regarding gender differences in survival and prognosis. The present study was aimed to investigate the interaction between gender and post resuscitation interventions on neurological outcome in an asphyxial rat model of cardiac arrest. Methods Asphyxia was induced by blocking the endotracheal tube in 120 adult Sprague–Dawley rats (60 males and 60 females) at the same age. Cardiopulmonary resuscitation (CPR) was started after 5 min of untreated cardiac arrest. Animals were randomized into one of the three post resuscitation care intervention groups (n = 40, 20 males) immediately after resuscitation: (1) normothermic control (NC): ventilated with 2% N2/98% O2 for 1 h under normothermia; (2) targeted temperature management (TTM): ventilated with 2% N2/98% O2 for 1 h under hypothermia; (3) hydrogen inhalation (HI): ventilated with 2% H2/98% O2 for 1 h under normothermia. Physiological variables were recorded during the 5 h post resuscitation monitoring period. Neurological deficit score (NDS) and accumulative survival were used to assess 96 h outcomes. Mutual independence analysis and Mantel–Haenszel stratified analysis were used to explore the associations among gender, intervention and survival. Results The body weights of female rats were significantly lighter than males, but CPR characteristics did not differ between genders. Compared with male rats, females had significantly lower mean arterial pressure, longer onset time of the electroencephalogram (EEG) burst and time to normal EEG trace (TTNT) in the NC group; relatively longer TTNT in the TTM group; and substantially longer TTNT, lower NDSs, and higher survival in the HI group. Mutual independence analysis revealed that both gender and intervention were associated with neurological outcome. Mantel–Haenszel stratified analysis demonstrated that female rats had significantly higher survival rate than males when adjusted for the confounder intervention. Conclusion In this rat model cardiac arrest and CPR, gender did not affect resuscitation but associated with neurological outcome. The superiority of female rats in neurological recovery was affected by post resuscitation interventions and female rats were more likely to benefit from hydrogen therapy.

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After a century, Epinephrine's role in cardiac arrest resuscitation remains controversial

Cited by 8 publications

References 44 publications

Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

Development and Evaluation of a Novel Mouse Model of Asphyxial Cardiac Arrest Revealed Severely Impaired Lymphopoiesis After Resuscitation

Interaction between gender and post resuscitation interventions on neurological outcome in an asphyxial rat model of cardiac arrest

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