Anesthesia Management: For Cardiac Arrest with Nonshockable Rhythm, Quicker Epinephrine Is Better

Delayed administration of epinephrine for patients with in-hosptial cardiac arrest is associated with increased mortality, according to a retrospective study in BMJ.

Using a resuscitation registry, researchers identified 25,000 inpatients who had a cardiac arrest with a nonshockable rhythm (e.g., asystole or pulseless electrical activity). Only 10% survived to discharge. Mortality increased in a stepwise fashion as the time to epinephrine administration increased. When epinephrine was administered 10 minutes or more after recognition of cardiac arrest, there was a reduced chance of survival to discharge (odds ratio, 0.63), compared with administration within 1 to 3 minutes. Quicker administration of epinephrine was also associated with increased chance of return of spontaneous circulation, 24-hour survival, and neurologically intact survival.

The authors conclude: “When a patient is not in a shockable rhythm, current standard of care focuses on cardiopulmonary resuscitation only… With such a large proportion of cardiac arrests being nonshockable rhythms, future quality metrics could conceivably focus on shortening the time to administration of epinephrine in these patients.”