Abstract 15755: Effects of Epinephrine on Rhythm Transitions in Out-of-Hospital Cardiac Arrest
Objectives: To study effects of intravenous epinephrine on rhythm transitions during cardiac arrest with initial or secondary ventricular fibrillation/tachycardia (VF/VT).
Methods: Post hoc analysis of patients included in a randomized controlled trial of intravenous drugs in adult, non-traumatic out-of-hospital cardiac arrest patients who were defibrillated and had a readable ECG recording. Patients who received epinephrine were compared to patients who did not. Cardiac rhythms were annotated manually using the defibrillator data. Continuous data are reported as median (interquartile range) and compared with Mann-Whitney U tests. Proportions are compared with Chi-square tests.
Results: Out of 849 patients included in the randomized trial 223 were included in this analysis; 119 in the epinephrine group and 104 in the no-epinephrine group. CPR quality was similar in the two groups.
The proportion of patients with one or more VF/VT episodes after ROSC was significantly (p=0.03) higher in the epinephrine (24%) group compared to the no-epinephrine (12%) group. Most relapses from ROSC to VF/VT in the no-epinephrine group occurred during the first 20 minutes of resuscitation, whereas patients in the epinephrine group continued to experience such relapses even after 20 minutes. Fibrillations from asystole or PEA was also more common in the epinephrine group, 90% versus 69%, p<0.001. Shock resistant VF occurred in 46% of patients who received epinephrine vs. 33% in those who did not, p=0.06.
The number of rhythm transitions per patient was higher in the epinephrine compared to the no-epinephrine group, median 8 (5,13) and 2 (1,5) respectively, p<0.001.
Conclusion: Patients who received epinephrine had more rhythm transitions from ROSC and non-shockable rhythms to VF.
- © 2013 by American Heart Association, Inc.