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A large observational study found that shorter intervals (<3 minutes) were associated with increased odds of survival with good neurologic function. Guidelines advise giving epinephrine every 3 to 5 minutes during cardiac arrest, but there is no evidence to support this dosing frequency. To study the association between dosing intervals and outcome, researchers performed a secondary analysis of data from a large trial of chest-compression technique during out-of-hospital arrest. An average dosing interval was defined as the interval from first dose of epinephrine to the end of the resuscitation, divided by the total number of doses. Patients were stratified by these average intervals: <3 minutes, 3 to 4 minutes, 4 to 5 minutes, or >5 minutes. Patients who received <2 doses of epinephrine or whose timing of doses could not be calculated were excluded. Of 26,148 patients in the trial, 15,909 were included in this analysis. The median age was 68 years, with 35% women, and 19% had shockable rhythms. The median dosing interval was 4.3 minutes and the demographics of the groups were similar. Survival with good neurologic outcome occurred in 5.0% of the <3-minute patients, compared with 2.1%, 1.4%, and 1.4%, respectively, in the other groups, in order of increasing time intervals. On adjusted analyses, the odds of a good outcome similarly decreased with increasing time intervals. |
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It remains unclear if epinephrine even increases neurologically intact survival, but giving it early is associated with better outcomes than giving it late, and now this study suggests that redosing rapidly is also associated with better outcomes. If you are using epinephrine for cardiac arrest, it is reasonable to dose it early and often at the beginning of the resuscitation (but realize when ongoing efforts are futile).