Total epinephrine dose during asystole and pulseless electrical activity cardiac arrests is associated with unfavourable functional outcome and increased in-hospital mortality.

AIM: Epinephrine is the drug of choice during advanced cardiac life support. The cumulative dose of epinephrine applied during resuscitation was shown to be independently associated with unfavourable outcome after ventricular fibrillation cardiac arrest in humans. Our objective was to investigate the association between the cumulative dose of epinephrine applied during resuscitation and unfavourable functional outcome and in-hospital mortality, in patients with asystole and pulseless electric activity.

METHODS: Data on 946 patients admitted to the emergency department after resuscitation of witnessed in-hospital and out-of hospital cardiac arrest with asystole or pulseless electric activity were retrieved from the cardiac arrest registry of the emergency department at the Vienna General Hospital/Medical University of Vienna. Data were documented according to Utstein Style. The risk factor was cumulative epinephrine categorized into quartiles. The endpoints were unfavourable functional outcome and in-hospital mortality.

RESULTS: The median cumulative amount of epinephrine administered was 2mg (IQR 0-5), ranging from 1 to 50mg. Of all patients 643/946 (68%) had an unfavourable functional outcome, 649/946 (69%) died during hospital stay. The multivariable analysis showed a statistically significant increasing risk for unfavourable functional outcome and in-hospital mortality outcome with increasing cumulative doses of epinephrine (unfavourable functional outcome: OR 1-1.45-2.25-2.95 over quartiles of epinephrine; in hospital mortality: OR 1-1.35-2.15-2.82 over quartiles of epinephrine).

CONCLUSION: Our results show that an increasing cumulative dose of epinephrine during resuscitation of patients with asystole and pulseless electric activity is an independent risk factor for unfavourable functional outcome and in-hospital mortality.