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.