Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Jami Smith
Second Advisor
Lisa Murphy
Abstract
Abstract
Introduction
Epinephrine administration during cardiac arrest has been the standard of care for decades. In the United States, epinephrine administration has been recommended by the American Heart Association since the first cardiac arrest guidelines were published in 1974. However, epinephrine use became the standard of care with strong medical rational but with limited data on outcomes. The intent of this research is to review available literature and determine if in (P) an adult population in non-traumatic out-of-hospital cardiac arrest (I) treatment with epinephrine administration (C) compared to cardiac care without the administration of epinephrine (O) results in improved survival with good neurologic outcomes.
Methods
A literature search was conducted in November 2018 using PubMed, Ovid, and Biomedical Reference Collection. After, applying exclusion criteria, a total of 16 articles were found. A total of 8 articles were selected based on the strongest level of evidence, research from various countries of origin, and in order to provide a well-rounded picture of how epinephrine administration is being researched.
Discussion
A lack of controlled trials, conflicting significant results, and findings without statistical significance prevented the research from demonstrating a clear benefit or harm associated with epinephrine administration for out-of-hospital cardiac arrest. A strong association between return of spontaneous circulation (ROSC) and epinephrine was found, but there was a lack of clear evidence to support improved survival or improved neurologic outcomes. Subpopulation analysis did support a time dependence of epinephrine administration with early administration being associated with improved survival and outcomes.
Conclusion
Although epinephrine during cardiac arrest has been the standard of care for decades and is associated with increased ROSC, there is no clear evidence for overall improved outcomes with its use. Animal studies proposed a mechanism that could account for decreased survival and neurologic function during post-resuscitation by decreasing cerebral microcirculation. This was supported by some early research that suggested epinephrine was generally associated with worse outcomes. However, it must be considered that repeat epinephrine administration is a marker of prolonged resuscitation efforts. Additionally, subpopulation analysis does provide strong evidence earlier epinephrine administration is associated with improved outcomes and moderate evidence that in cases non-shockable initial rhythms epinephrine administration improves overall outcomes. Continued research into the timing and dosage of epinephrine administration is warranted.
Recommended Citation
Lumsden, Ian, "Effect of Epinephrine on outcomes in Out-of-Hospital Cardiac Arrest" (2020). Capstone Showcase. 10.
https://scholarworks.arcadia.edu/showcase/2020/pa/10
Effect of Epinephrine on outcomes in Out-of-Hospital Cardiac Arrest
Abstract
Introduction
Epinephrine administration during cardiac arrest has been the standard of care for decades. In the United States, epinephrine administration has been recommended by the American Heart Association since the first cardiac arrest guidelines were published in 1974. However, epinephrine use became the standard of care with strong medical rational but with limited data on outcomes. The intent of this research is to review available literature and determine if in (P) an adult population in non-traumatic out-of-hospital cardiac arrest (I) treatment with epinephrine administration (C) compared to cardiac care without the administration of epinephrine (O) results in improved survival with good neurologic outcomes.
Methods
A literature search was conducted in November 2018 using PubMed, Ovid, and Biomedical Reference Collection. After, applying exclusion criteria, a total of 16 articles were found. A total of 8 articles were selected based on the strongest level of evidence, research from various countries of origin, and in order to provide a well-rounded picture of how epinephrine administration is being researched.
Discussion
A lack of controlled trials, conflicting significant results, and findings without statistical significance prevented the research from demonstrating a clear benefit or harm associated with epinephrine administration for out-of-hospital cardiac arrest. A strong association between return of spontaneous circulation (ROSC) and epinephrine was found, but there was a lack of clear evidence to support improved survival or improved neurologic outcomes. Subpopulation analysis did support a time dependence of epinephrine administration with early administration being associated with improved survival and outcomes.
Conclusion
Although epinephrine during cardiac arrest has been the standard of care for decades and is associated with increased ROSC, there is no clear evidence for overall improved outcomes with its use. Animal studies proposed a mechanism that could account for decreased survival and neurologic function during post-resuscitation by decreasing cerebral microcirculation. This was supported by some early research that suggested epinephrine was generally associated with worse outcomes. However, it must be considered that repeat epinephrine administration is a marker of prolonged resuscitation efforts. Additionally, subpopulation analysis does provide strong evidence earlier epinephrine administration is associated with improved outcomes and moderate evidence that in cases non-shockable initial rhythms epinephrine administration improves overall outcomes. Continued research into the timing and dosage of epinephrine administration is warranted.