Abstract 289: Use of Epinephrine During In-Hospital Cardiac Arrest May Not Increase Rate of Survival to Discharge
Introduction: In a recent large observational resuscitation study the use of epinephrine during out-of-hospital cardiac arrest was associated with survival to hospital admission but not with survival to discharge. Few studies have studied the impact of epinephrine on in-hospital survival outcomes. This study examines in-hospital cardiac arrest survival and the use of epinephrine.
Hypothesis: The use of epinephrine during in-hospital cardiac arrest is associated with increased code survival and survival to discharge.
Methods: This retrospective and observational study includes 286 cases of in-hospital cardiac arrest wherein epinephrine was administered. The outcomes were code survival and survival to discharge. The study period was between June 2010 and October 2011 at an urban, academic medical center. Resuscitation characteristics, including use of epinephrine were compared between code survivors and non-survivors. Charlson comorbidity scores were used to adjust the severity of illness for both groups. Chi-square was used for hypothesis testing. Results were considered significant for p-values < 0.05.
Results: Epinephrine was used in 272 cases of in-hospital cardiac arrest. In 55% (n = 136) of the study cohort, only one dose of epinephrine was administered. There is a significant association between the use of epinephrine and code survival (X2 = 9.87, p = 0.0017). There is a statistically significant association between the use of epinephrine and not surviving to discharge (X2 = 7.69, p = 0.0056). Among persons receiving epinephrine, 13.6% (n = 37 of 272) survived to hospital discharge. There is no significant association between the initial rhythm and code survival (X2 = 75.36, p = 0.34) or survival to discharge (X2 = 4.56, p = 0.47) when epinephrine was administered. The median Charlson score for both groups was 4 (IQR = 2 to 6) and is not significantly different (Ws = 10955, z = 1.24, p = 0.21).
Conclusions: Epinephrine administration during in-hospital cardiac arrest is associated with code survival, but not survival to discharge. Our observations are consistent with the findings reported regarding epinephrine use in out-of-hospital cardiac arrest but warrant larger, randomized studies to confirm our findings
- © 2012 by American Heart Association, Inc.