1
|
Hou M, Dong S, Kan Q, Ouyang M, Zhang Y. Is epinephrine still the drug of choice during cardiac arrest in the emergency department of the hospital? A meta-analysis. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:325-339. [PMID: 37708961 DOI: 10.2478/acph-2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 09/16/2023]
Abstract
Epinephrine is the first-line emergency drug for cardiac arrest and anaphylactic reactions but is reported to be associated with many challenges resulting in its under- or improper utilization. Therefore, in this meta-analysis, the efficacy and safety of epinephrine as a first-line cardiac emergency drug for both out-of-hospital and in-hospital patients was assessed. Pertinent articles were searched in central databases like PubMed, Scopus, and Web of Science, using appropriate keywords as per the PRISMA guidelines. Retrospective and prospective studies were included according to the predefined PICOS criteria. RevMan and MedCalc software were used and statistical parameters such as odds ratio and risk ratio were calculated. Twelve clinical trials with a total of 208,690 cardiac arrest patients from 2000 to 2022 were included, in accordance with the chosen inclusion criteria. In the present meta-analysis, a high odds ratio (OR) value of 3.67 (95 % CI 2.32-5.81) with a tau2 value of 0.64, a chi2 value of 12,446.86, df value of 11, I2 value of 100 %, Z-value 5.53, and a p-value < 0.00001 were reported. Similarly, the risk ratio of 1.89 (95 % CI 1.47-2.43) with a tau2 value of 0.19, chi2 value of 11,530.67, df value of 11, I2 value of 100 %, Z-value of 4.95, and p-value < 0.000001. The present meta-analysis strongly prefers epinephrine injection as the first cardiac emergency drug for both out-of-hospital and in-hospital patients during cardiac arrest.
Collapse
Affiliation(s)
- Min Hou
- Department of Cardiovascular Internal Medicine, People's Hospital of Dongxihu District, Wuhan, Wuhan City, Hubei Province, 430040, China
| | - Su Dong
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan Wuhan City, Hubei Province, 430040 China
| | - Qing Kan
- Department of Pharmacy, Hankou Hospital of Wuhan, Wuhan City, Hubei Province, 430040, China
| | - Meng Ouyang
- Department of Pharmacy, The First People's Hospital of Jiang Xia District Wuhan City, Hubei Province, 430000 China
| | - Yun Zhang
- Department of Pharmacy, The First People's Hospital of Jiang Xia District Wuhan City, Hubei Province, 430000 China
| |
Collapse
|
2
|
Jaeger D, Marquez AM, Kosmopoulos M, Gutierrez A, Gaisendrees C, Orchard D, Chouihed T, Yannopoulos D. A Narrative Review of Drug Therapy in Adult and Pediatric Cardiac Arrest. Rev Cardiovasc Med 2023; 24:163. [PMID: 39077526 PMCID: PMC11264139 DOI: 10.31083/j.rcm2406163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 07/31/2024] Open
Abstract
Drugs are used during cardiopulmonary resuscitation (CPR) in association with chest compressions and ventilation. The main purpose of drugs during resuscitation is either to improve coronary perfusion pressure and myocardial perfusion in order to achieve return of spontaneous circulation (ROSC). The aim of this up-to-date review is to provide an overview of the main drugs used during cardiac arrest (CA), highlighting their historical context, pharmacology, and the data to support them. Epinephrine remains the only recommended vasopressor. Regardless of the controversy about optimal dosage and interval between doses in recent papers, epinephrine should be administered as early as possible to be the most effective in non-shockable rhythms. Despite inconsistent survival outcomes, amiodarone and lidocaine are the only two recommended antiarrhythmics to treat shockable rhythms after defibrillation. Beta-blockers have also been recently evaluated as antiarrhythmic drugs and show promising results but further evaluation is needed. Calcium, sodium bicarbonate, and magnesium are still widely used during resuscitation but have shown no benefit. Available data may even suggest a harmful effect and they are no longer recommended during routine CPR. In experimental studies, sodium nitroprusside showed an increase in survival and favorable neurological outcome when combined with enhanced CPR, but as of today, no clinical data is available. Finally, we review drug administration in pediatric CA. Epinephrine is recommended in pediatric CA and, although they have not shown any improvement in survival or neurological outcome, antiarrhythmic drugs have a 2b recommendation in the current guidelines for shockable rhythms.
Collapse
Affiliation(s)
- Deborah Jaeger
- Center for Resuscitation Medicine, University of Minnesota Medical School,
Minneapolis, MN 55455, USA
- INSERM U 1116, University of Lorraine, 54500 Vandœuvre-lès-Nancy,
France
- Division of Cardiology, Department of Medicine, University of Minnesota
Medical School, Minneapolis, MN 55455, USA
| | - Alexandra M. Marquez
- Center for Resuscitation Medicine, University of Minnesota Medical School,
Minneapolis, MN 55455, USA
- Division of Cardiology, Department of Medicine, University of Minnesota
Medical School, Minneapolis, MN 55455, USA
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School,
Minneapolis, MN 55455, USA
- Division of Cardiology, Department of Medicine, University of Minnesota
Medical School, Minneapolis, MN 55455, USA
| | - Alejandra Gutierrez
- Center for Resuscitation Medicine, University of Minnesota Medical School,
Minneapolis, MN 55455, USA
- Division of Cardiology, Department of Medicine, University of Minnesota
Medical School, Minneapolis, MN 55455, USA
| | - Christopher Gaisendrees
- Center for Resuscitation Medicine, University of Minnesota Medical School,
Minneapolis, MN 55455, USA
- Division of Cardiology, Department of Medicine, University of Minnesota
Medical School, Minneapolis, MN 55455, USA
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne,
50937 Cologne, Germany
| | - Devin Orchard
- University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Tahar Chouihed
- INSERM U 1116, University of Lorraine, 54500 Vandœuvre-lès-Nancy,
France
- Emergency Department, University Hospital of Nancy, 54000 Nancy, France
| | - Demetri Yannopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School,
Minneapolis, MN 55455, USA
- Division of Cardiology, Department of Medicine, University of Minnesota
Medical School, Minneapolis, MN 55455, USA
| |
Collapse
|
3
|
Kim JS, Ryoo SM, Kim YJ, Sohn CH, Ahn S, Seo DW, Hong SI, Kim SM, Chae B, Kim WY. Augmented-Medication CardioPulmonary Resuscitation Trials in out-of-hospital cardiac arrest: a pilot randomized controlled trial. Crit Care 2022; 26:378. [PMID: 36476543 PMCID: PMC9727995 DOI: 10.1186/s13054-022-04248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previously conducted physician-centered trials on the usefulness of vasopressin have yielded negative results; thus, patient-oriented trials have been warranted. We hypothesize that Augmented-Medication CardioPulmonary Resuscitation could be helpful for selected patients with out-of-hospital cardiac arrest (OHCA). METHODS This is a double-blind, single-center, randomized, placebo-controlled trial conducted in the emergency department in a tertiary, university-affiliated hospital in Seoul, Korea. A total of 148 adults with non-traumatic OHCA who had initial diastolic blood pressure (DBP) < 20 mm Hg via invasive arterial monitoring during the early cardiac compression period were randomly assigned to two groups. Patients received a dose of 40 IU of vasopressin or placebo with initial epinephrine. The primary endpoint was a sustained return of spontaneous circulation. Secondary endpoints were survival discharge, and neurologic outcomes at discharge. RESULTS Of the 180 included patients, 32 were excluded, and 148 were enrolled in the trial. A sustained return of spontaneous circulation was achieved by 27 patients (36.5%) in the vasopressin group and 24 patients (32.4%) in the control group (risk difference, 4.1%; P = .60). Survival discharge and good neurologic outcomes did not differ between groups. The trial group had significantly higher median DBPs during resuscitation than the control group (16.0 vs. 14.5 mm Hg, P < 0.01). There was no difference in end-tidal carbon dioxide, acidosis, and lactate levels at baseline, 10 min, and end-time. CONCLUSION Among patients with refractory vasodilatory shock in OHCA, administration of vasopressin, compared with placebo, did not significantly increase the likelihood of return of spontaneous circulation.
Collapse
Affiliation(s)
- June-sung Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Seung Mok Ryoo
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Youn-Jung Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Chang Hwan Sohn
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Shin Ahn
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Dong Woo Seo
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Seok In Hong
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Sang-Min Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Bora Chae
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Won Young Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| |
Collapse
|
4
|
Oghifobibi OA, Toader AE, Nicholas MA, Nelson BP, Alindogan NG, Wolf MS, Kline AE, Nouraie SM, Bondi CO, Iordanova B, Clark RS, Bayır H, Loughran PA, Watkins SC, St Croix CM, Kochanek PM, Vazquez AL, Manole MD. Resuscitation with epinephrine worsens cerebral capillary no-reflow after experimental pediatric cardiac arrest: An in vivo multiphoton microscopy evaluation. J Cereb Blood Flow Metab 2022; 42:2255-2269. [PMID: 35854408 PMCID: PMC9670003 DOI: 10.1177/0271678x221113022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Epinephrine is the principal resuscitation therapy for pediatric cardiac arrest (CA). Clinical data suggest that although epinephrine increases the rate of resuscitation, it fails to improve neurological outcome, possibly secondary to reductions in microvascular flow. We characterized the effect of epinephrine vs. placebo administered at resuscitation from pediatric asphyxial CA on microvascular and macrovascular cortical perfusion assessed using in vivo multiphoton microscopy and laser speckle flowmetry, respectively, and on brain tissue oxygenation (PbO2), behavioral outcomes, and neuropathology in 16-18-day-old rats. Epinephrine-treated rats had a more rapid return of spontaneous circulation and brisk immediate cortical reperfusion during 1-3 min post-CA vs. placebo. However, at the microvascular level, epinephrine-treated rats had penetrating arteriole constriction and increases in both capillary stalling (no-reflow) and cortical capillary transit time 30-60 min post-CA vs. placebo. Placebo-treated rats had increased capillary diameters post-CA. The cortex was hypoxic post-CA in both groups. Epinephrine treatment worsened reference memory performance vs. shams. Hippocampal neuron counts did not differ between groups. Resuscitation with epinephrine enhanced immediate reperfusion but produced microvascular alterations during the first hour post-resuscitation, characterized by vasoconstriction, capillary stasis, prolonged cortical transit time, and absence of compensatory cortical vasodilation. Targeted therapies mitigating the deleterious microvascular effects of epinephrine are needed.
Collapse
Affiliation(s)
- Onome A Oghifobibi
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA
| | - Andrew E Toader
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, USA
| | - Melissa A Nicholas
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA
| | - Brittany P Nelson
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA
| | - Nicole G Alindogan
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA
| | - Michael S Wolf
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Anthony E Kline
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - Seyed M Nouraie
- Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Corina O Bondi
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - Bistra Iordanova
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| | - Robert Sb Clark
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA.,Children's Neuroscience Institute, UPMC Children's Hospital, Pittsburgh, USA
| | - Hülya Bayır
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA.,Children's Neuroscience Institute, UPMC Children's Hospital, Pittsburgh, USA
| | | | - Simon C Watkins
- Department of Cell Biology, Center for Biologic Imaging University of Pittsburgh, Pittsburgh, USA
| | - Claudette M St Croix
- Department of Cell Biology, Center for Biologic Imaging University of Pittsburgh, Pittsburgh, USA
| | - Patrick M Kochanek
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA.,Children's Neuroscience Institute, UPMC Children's Hospital, Pittsburgh, USA
| | - Alberto L Vazquez
- Department of Radiology, University of Pittsburgh, Pittsburgh, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| | - Mioara D Manole
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA.,Children's Neuroscience Institute, UPMC Children's Hospital, Pittsburgh, USA
| |
Collapse
|
5
|
Gao Q, Mok HP, Qiu HL, Cen J, Chen J, Zhuang J. Accumulated Epinephrine Dose is Associated With Acute Kidney Injury Following Resuscitation in Adult Cardiac Arrest Patients. Front Pharmacol 2022; 13:806592. [PMID: 35126162 PMCID: PMC8811500 DOI: 10.3389/fphar.2022.806592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
The goal of this study was to investigate the association between total epinephrine dosage during resuscitation and acute kidney injury after return of spontaneous circulation in patients with cardiac arrest. We performed a secondary analysis of previously published data on the resuscitation of cardiac arrest patients. Bivariate, multivariate logistic regression, and subgroup analyses were conducted to investigate the association between total epinephrine dosage during resuscitation and acute kidney injury after return of spontaneous circulation. A total of 312 eligible patients were included. The mean age of the patients was 60.8 ± 15.2 years. More than half of the patients were male (73.4%) and had an out-of-hospital cardiac arrest (61.9%). During resuscitation, 125, 81, and 106 patients received ≤2, 3 - 4, and ≥5 mg epinephrine, respectively. After return of spontaneous circulation, there were 165 patients (52.9%) and 147 patients (47.1%) with and without acute kidney injury, respectively. Both bivariate and multivariate analysis showed a statistically significant association between total epinephrine dosage and acute kidney injury. The subgroup analysis showed that the strength of the association between epinephrine dosage and acute kidney injury varied by location of cardiac arrest. Further multivariate regression analysis found that the association between epinephrine dosage and acute kidney injury was only observed in patients with in-hospital cardiac arrest after adjusting for multiple confounding factors. Compared with in-hospital cardiac arrest patients who received ≤2 mg of epinephrine, patients with 3–4 mg of epinephrine or ≥5 mg of epinephrine had adjusted odds ratios of 4.2 (95% confidence interval 1.0–18.4) and 11.3 (95% confidence interval 2.0–63.0), respectively, to develop acute kidney injury. Therefore, we concluded that a higher epinephrine dosage during resuscitation was associated with an increased incidence of acute kidney injury after return of spontaneous circulation in adult patients with in-hospital cardiac arrest.
Collapse
Affiliation(s)
- Qiang Gao
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hsiao-Pei Mok
- Department of Breast Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai-Long Qiu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Jian Zhuang,
| |
Collapse
|
6
|
Evans E, Swanson MB, Mohr N, Boulos N, Vaughan-Sarrazin M, Chan PS, Girotra S. Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis. BMJ 2021; 375:e066534. [PMID: 34759038 PMCID: PMC8579224 DOI: 10.1136/bmj-2021-066534] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the use of epinephrine (adrenaline) before defibrillation for treatment of in-hospital cardiac arrest due to a ventricular arrhythmia and examine its association with patient survival. DESIGN Propensity matched analysis. SETTING 2000-18 data from 497 hospitals participating in the American Heart Association’s Get With The Guidelines-Resuscitation registry. PARTICIPANTS Adults aged 18 and older with an index in-hospital cardiac arrest due to an initial shockable rhythm treated with defibrillation. INTERVENTIONS Administration of epinephrine before first defibrillation. MAIN OUTCOME MEASURES Survival to discharge; favorable neurological survival, defined as survival to discharge with none, mild, or moderate neurological disability measured using cerebral performance category scores; and survival after acute resuscitation (that is, return of spontaneous circulation for >20 minutes). A time dependent, propensity matched analysis was performed to adjust for confounding due to indication and evaluate the independent association of epinephrine before defibrillation with study outcomes. RESULTS Among 34 820 patients with an initial shockable rhythm, 7054 (20.3%) were treated with epinephrine before defibrillation, contrary to current guidelines. In comparison with participants treated with defibrillation first, participants receiving epinephrine first were less likely to have a history of myocardial infarction or heart failure, but more likely to have renal failure, sepsis, respiratory insufficiency, and receive mechanical ventilation before in-hospital cardiac arrest (standardized differences >10% for all). Treatment with epinephrine before defibrillation was strongly associated with delayed defibrillation (median 4 minutes v 0 minutes). In propensity matched analysis (6569 matched pairs), epinephrine before defibrillation was associated with lower odds of survival to discharge (22.4% v 29.7%; adjusted odds ratio 0.69; 95% confidence interval 0.64 to 0.74; P<0.001), favorable neurological survival (15.8% v 21.6%; 0.68; 0.61 to 0.76; P<0.001) and survival after acute resuscitation (61.7% v 69.5%; 0.73; 0.67 to 0.79; P<0.001). The above findings were consistent in a range of sensitivity analyses, including matching according to defibrillation time. CONCLUSIONS Contrary to current guidelines that prioritize immediate defibrillation for in-hospital cardiac arrest due to a shockable rhythm, one in five patients are treated with epinephrine before defibrillation. Use of epinephrine before defibrillation was associated with worse survival outcomes.
Collapse
Affiliation(s)
- Erin Evans
- Department of Emergency Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Morgan B Swanson
- Department of Emergency Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Nicholas Mohr
- Department of Emergency Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Nassar Boulos
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mary Vaughan-Sarrazin
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Centre for Access Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Centre, Iowa City, IA, USA
| | - Paul S Chan
- Saint Luke's Mid America Heart and Vascular Institute, University of Missouri-Kansas, Kansas City, MO, USA
| | - Saket Girotra
- Centre for Access Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Centre, Iowa City, IA, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
7
|
Vandersmissen H, Gworek H, Dewolf P, Sabbe M. Drug use during adult advanced cardiac life support: An overview of reviews. Resusc Plus 2021; 7:100156. [PMID: 34430950 PMCID: PMC8371248 DOI: 10.1016/j.resplu.2021.100156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 01/08/2023] Open
Abstract
AIM To conduct an overview of systematic reviews and meta-analyses to summarize the ever-growing evidence on drug use during advanced life support. METHODS We searched Embase, Medline, Cochrane central register of controlled trials and Web of science for systematic reviews and meta-analyses reporting on drug use during advanced life support from inception to March, 2020. Two reviewers independently assessed all abstracts for eligibility, extracted data and assessed risk of bias using the AMSTAR-2 tool. Corrected covered areas were calculated from publication citation matrices to account for potential risk of bias. Data were graphically represented using forest plots. RESULTS Twenty-two head-to-head drug comparisons from 47 included articles were analysed. Adrenaline significantly increases the incidence of return of spontaneous circulation and survival to hospital discharge, but not the incidence of neurological intact survival. Vasopressin alone or in combination with adrenaline is not superior to adrenaline alone. There is a trend favouring lidocaine over amiodarone in shockable cardiac arrest. The risk of bias assessment of included studies ranged from very low to very high and the overlap between articles was moderate to high. CONCLUSIONS In line with the guidelines, we currently suggest that a standard dose of adrenaline should be administered during resuscitation, however, studies assessing lower doses of adrenaline are pressing. There is no rationale for the combination of vasopressin and adrenaline or vasopressin alone instead of adrenaline. In addition, lidocaine is a valuable alternative for amiodarone and maybe even preferable for shockable cardiac arrest. However more research is necessary.
Collapse
Affiliation(s)
- Hans Vandersmissen
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Hanne Gworek
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Philippe Dewolf
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Department of Public Health and Primary Care, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Marc Sabbe
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium
- KULeuven, Department of Public Health and Primary Care, Leuven, Belgium
- KULeuven, Faculty of Medicine, Leuven, Belgium
| |
Collapse
|
8
|
Schwalbach KT, Yong SS, Chad Wade R, Barney J. Impact of intraosseous versus intravenous resuscitation during in-hospital cardiac arrest: A retrospective study. Resuscitation 2021; 166:7-13. [PMID: 34273470 DOI: 10.1016/j.resuscitation.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/22/2021] [Accepted: 07/04/2021] [Indexed: 11/20/2022]
Abstract
AIM To compare outcomes between Intraosseous (IO) and peripheral intravenous (PIV) injection during in-hospital cardiac arrest (IHCA) and examine its utility in individuals with obesity. METHODS We performed a retrospective cohort analysis of adult, atraumatic IHCA at a single tertiary care center. Subjects were classified as either IO or PIV resuscitation. The primary outcome of interest was survival to hospital discharge. The secondary outcomes of interest were survival with favourable neurologic status, rates-of-ROSC (ROR) and time-to-ROSC (TTR). Subgroup analysis among patients with BMI ≥ 30 kg/m2 was performed. RESULTS Complete data were available for 1852 subjects, 1039 of whom met eligibility criteria. A total of 832 were resuscitated via PIV route and 207 via IO route. Use of IO compared to PIV was associated with lower overall survival to hospital discharge (20.8% vs 28.4% p = 0.03), lower rates of survival with favourable neurologic status (18.4% vs 25.2% p = 0.04), lower ROR (72.2% vs 80.7%) and longer TTR (12:38 min vs 9:01 min). After multivariate adjustment there was no significant differences between IO and PIV in rates of survival to discharge (OR 0.71, 95% CI 0.47-1.06, p = 0.09) or rates of survival with favourable neurologic status (OR 0.74, 95% CI 0.49-1.13, p = 0.16). The ROR and TTR remained significantly worse in the IO group. Subgroup analysis of patients with BMI ≥ 30 kg/m2 identified no benefit or harm with use of IO compared to PIV. CONCLUSION Intraosseous medication delivery is associated with inferior rates-of-ROSC and longer times-to-ROSC compared to PIV, but no differences in overall survival to hospital discharge or survival with favourable neurologic status during IHCA.
Collapse
Affiliation(s)
- Kevin T Schwalbach
- University of Alabama at Birmingham, Department of Medicine, 1720 2nd Ave South, BDB 321, Birmingham, AL 35294-0012, United States
| | - Sylvia S Yong
- University of Alabama at Birmingham, Department of Medicine, 1720 2nd Ave South, BDB 321, Birmingham, AL 35294-0012, United States
| | - R Chad Wade
- University of Alabama at Birmingham Division of Pulmonary, Allergy and Critical Care Medicine, 1900 University Blvd., Tinsley Harrison Tower, Suite 422, Birmingham, AL 35294, United States
| | - Joseph Barney
- University of Alabama at Birmingham Division of Pulmonary, Allergy and Critical Care Medicine, 1900 University Blvd., Tinsley Harrison Tower, Suite 422, Birmingham, AL 35294, United States.
| |
Collapse
|
9
|
Bornstein K, Long B, Porta AD, Weinberg G. After a century, Epinephrine's role in cardiac arrest resuscitation remains controversial. Am J Emerg Med 2021; 39:168-172. [DOI: 10.1016/j.ajem.2020.08.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
|