Abstract 110: The Association Between the Timing of Epinephrine (Adrenalin) Administration and Survival from Out-of-Hospital Ventricular Fibrillation Arrest
Introduction: The benefit of epinephrine administration by emergency medical services providers (EMS) during resuscitation of patients with out-of-hospital-cardiac arrest (OHCA) is controversial. To address the association of the timing of epinephrine administration and outcome, we accessed the Save Hearts in Arizona Register and Educational (SHARE) program registry, and analyzed the time between 9-1-1 dispatches, the first dose of epinephrine and survival to hospital discharge.
Methods: A retrospective analysis of prospectively collected statewide OHCA data using the SHARE database between October 2004 and December 2013.
Results: There were 2,213 OHCA with a shockable initial rhythm who received epinephrine by EMS. Logistic regression was performed adjusted for age, gender, witnessed, bystander CPR, arrival time (dispatch to scene), and dispatch to defibrillation time, year, and method of ventilation. Of these, 396 (17.8%) survived to discharge. The times from dispatch to first epinephrine administration were analyzed. Survival progressively decreased with longer time intervals of epinephrine administration: Survival, < 9 min (99/398) 24.8%, 9-13 min (216/1,058) 20.4% and >13 min (81/757) 10.7%. The Adjusted odds ratio for decreased survival for the group receiving epinephrine after 13 minutes was 2.32 (95% CI 1.5-3.4) (p<0.0001). The neurological CPC Scores of the 242 survivors was also related to time delay of epinephrine administration: CPC 1 or 2 were; < 9 min 69 (17.3%), 9-13 min 132 (12.4%), >13 min 47 (6.2%). Survival was significantly less in those receiving epinephrine >13 min after EMS arrival (Chi Square p<0.0001).
Conclusion: In this retrospective database analysis, epinephrine administered by EMS to patients with OHCA and a shockable rhythm in <13 min from dispatch was associated with significant improvement in survival compared to epinephrine administered >13 min after dispatch.
Author Disclosures: G.A. Ewy: None. B.J. Bobrow: Research Grant; Significant; Medtronic Foundation. V. Chikani: None. A.B. Sanders: None. C.W. Otto: None. M. Zuercher: None. D. Spaite: Research Grant; Significant; Medtronic Foundation. K.B. Kern: Research Grant; Significant; Zoll Medical. Consultant/Advisory Board; Modest; Zoll Medical. Consultant/Advisory Board; Significant; PhysioControl.
- © 2014 by American Heart Association, Inc.