Abstract 2689: Erythropoietin Facilitates Return of Spontaneous Circulation and Subsequent ICU Admission in Victims of Out-of-Hospital Cardiac Arrest
Erythropoietin is known to signal potent non-genomic (immediate) and genomic (delayed) cell protective and survival effects. In a rat model of VF, erythropoietin preserved myocardial compliance enabling hemodynamically more effective chest compression and improved post-resuscitation hemodynamic function. We investigated whether erythropoietin improves resuscitation outcomes in victims of out-of-hospital cardiac arrest. 54 victims aged 19 to 80 were allocated to receive 90,000 IU of beta-epoetin (n = 24) or NaCl 0.9% (n = 30) through a peripheral vein within 2 minutes of CPR performed by a physician-led ACLS-trained rescue squad in a city of ≈ 200,000 people from April 2007 to May 2008. Successfully resuscitated victims were admitted to the ICU of a single receiving hospital that provided percutaneous coronary intervention, hypothermia, and post-resuscitation hemodynamic management. After adjustment for age, male sex, witnessed arrest, time from call to start CPR, PEA, asystole, and bystander CPR (using multiple logistic regression) administration of erythropoietin was associated with increased rate of ICU admission (primary outcome) and increased return of spontaneous circulation with statistically unadjusted increases in survival at 24 hours and survival at hospital discharge (secondary outcomes) (Table⇓). Erythropoietin was also associated with higher end-tidal PCO2 during resuscitation pointing to hemodynamically more effective chest compression. Survivors to hospital discharge had comparable rates of neurological recovery. Erythropoietin given early during cardiac resuscitation facilitates the return of spontaneous circulation and subsequent ICU admission. The effect is hypothesized to result from myocardial protection prompting (among other possible benefits) preservation of myocardial compliance leading to hemodynamically more effective chest compression.