Paramedic compliance with ACLS epinephrine guidelines in out-of-hospital cardiac arrest.

OBJECTIVE: The purpose of this observational study was to determine the baseline rate of adherence to current American Heart Association guidelines with regard to use of epinephrine in out-of-hospital cardiac arrests.

METHODS: A structured explicit retrospective review of all adult victims of cardiac arrest logged in the EMSCQI.com database during its first 20 months in operation from February 2004 to October 2005. Noncompliance was defined as epinephrine administration on average less than every three minutes or greater than every five minutes regardless of dosage. Primary determination of noncompliance was calculated by dividing the time from first epinephrine dose to hospital arrival by the number of subsequent doses given during that time frame.

RESULTS: Seventy-five of 11,000 advanced life support calls were identified as out-of-hospital cardiac arrests. The overall rate of noncompliance was 86% (95% confidence interval, 75-93%). The average time from the first epinephrine administration to hospital arrival was 22.6 minutes. The median number of epinephrine doses per patient was three. All patients in the noncompliant group received epinephrine less often than every five minutes. The data did not allow for examination of noncompliance predictors.

CONCLUSIONS: Epinephrine administration in accordance with current advanced cardiac life support guidelines occurred in 14% of out-of-hospital cardiac arrest patients.