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The influences of adrenaline dosing frequency and dosage on outcomes of adult in-hospital cardiac arrest: A retrospective cohort study

  • Chih-Hung Wang
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Chien-Hua Huang
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Wei-Tien Chang
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Min-Shan Tsai
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Ping-Hsun Yu
    Affiliations
    Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
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  • Yen-Wen Wu
    Affiliations
    Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    National Yang-Ming University School of Medicine, Taipei, Taiwan
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  • Kuan-Yu Hung
    Affiliations
    Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Wen-Jone Chen
    Correspondence
    Corresponding author at: National Taiwan University Hospital, Department of Emergency Medicine, No. 7 Chung-Shan S. Rd, Taipei, Taiwan. Fax: +886 2 2322 3150.
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan
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      Abstract

      Aim

      To investigate the influence of dosing frequency and dosage of adrenaline on outcomes of cardiopulmonary resuscitation (CPR).

      Methods

      We conducted a retrospective observational study in a single medical centre and included adult patients who had suffered an in-hospital cardiac arrest between 2006 and 2012. We used multivariable logistic regression analysis to evaluate the associations between independent variables and outcomes. Adrenaline average dosing frequency was calculated as the total dosage of adrenaline administered during CPR divided by the duration of CPR. Body weight (BW) was analysed as an interaction term to investigate the effect of adrenaline dosage on outcomes. Favourable neurological outcome was defined as a score of 1 or 2 on the Cerebral Performance Category scale at hospital discharge.

      Results

      We included 896 patients in the analysis. After adjusting for multiple confounding factors, including CPR duration, the results indicated that higher adrenaline dosing frequency was associated with lower rates of survival (odds ratio (OR): 0.05, 95% confidence interval (CI): 0.01–0.23) and favourable neurological outcome at hospital discharge (OR: 0.02, 95% CI: 0.002–0.16). A significant interaction was noted between total adrenaline dosage and BW, which indicated that, with the same adrenaline dosage, the outcomes for patients with BW ≥ 82.5 kg would be worse than those for patients with lower BW.

      Conclusion

      Higher adrenaline average dosing frequency may be associated with worse outcomes after CPR. Besides, according to current recommendations, patients with BW above 82.5 kg may not receive adequate dose of adrenaline.

      Keywords

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      References

        • Deakin C.D.
        • Nolan J.P.
        • Soar J.
        • et al.
        European Resuscitation Council guidelines for resuscitation 2010 Section 4. Adult advanced life support.
        Resuscitation. 2010; 81: 1305-1352
        • Morrison L.J.
        • Deakin C.D.
        • Morley P.T.
        • et al.
        Part 8: Advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
        Circulation. 2010; 122: S345-S421
        • Neumar R.W.
        • Otto C.W.
        • Link M.S.
        • et al.
        Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2010; 122: 729-767
        • Safar P.
        Community-wide cardiopulmonary resuscitation.
        J Iowa Med Soc. 1964; 54: 629-635
        • Fries M.
        • Tang W.
        • Chang Y.T.
        • Wang J.
        • Castillo C.
        • Weil M.H.
        Microvascular blood flow during cardiopulmonary resuscitation is predictive of outcome.
        Resuscitation. 2006; 71: 248-253
        • Ristagno G.
        • Tang W.
        • Huang L.
        • et al.
        Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation.
        Crit Care Med. 2009; 37: 1408-1415
        • Laver S.
        • Farrow C.
        • Turner D.
        • Nolan J.
        Mode of death after admission to an intensive care unit following cardiac arrest.
        Intensive Care Med. 2004; 30: 2126-2128
        • Dragancea I.
        • Rundgren M.
        • Englund E.
        • Friberg H.
        • Cronberg T.
        The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest.
        Resuscitation. 2013; 84: 337-342
        • Olasveengen T.M.
        • Wik L.
        • Sunde K.
        • Steen P.A.
        Outcome when adrenaline (epinephrine) was actually given vs. not given—post hoc analysis of a randomized clinical trial.
        Resuscitation. 2012; 83: 327-332
        • Jacobs I.G.
        • Finn J.C.
        • Jelinek G.A.
        • Oxer H.F.
        • Thompson P.L.
        Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial.
        Resuscitation. 2011; 82: 1138-1143
        • Hagihara A.
        • Hasegawa M.
        • Abe T.
        • Nagata T.
        • Wakata Y.
        • Miyazaki S.
        Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.
        JAMA. 2012; 307: 1161-1168
        • Ong M.E.
        • Tan E.H.
        • Ng F.S.
        • et al.
        Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest.
        Ann Emerg Med. 2007; 50: 635-642
        • Kosnik J.W.
        • Jackson R.E.
        • Keats S.
        • Tworek R.M.
        • Freeman S.B.
        Dose-related response of centrally administered epinephrine on the change in aortic diastolic pressure during closed-chest massage in dogs.
        Ann Emerg Med. 1985; 14: 204-208
        • Paradis N.A.
        • Martin G.B.
        • Rosenberg J.
        • et al.
        The effect of standard- and high-dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation.
        JAMA. 1991; 265: 1139-1144
        • Wortsman J.
        • Paradis N.A.
        • Martin G.B.
        • et al.
        Functional responses to extremely high plasma epinephrine concentrations in cardiac arrest.
        Crit Care Med. 1993; 21: 692-697
        • Bar-Joseph G.
        • Weinberger T.
        • Ben-Haim S.
        Response to repeated equal doses of epinephrine during cardiopulmonary resuscitation in dogs.
        Ann Emerg Med. 2000; 35: 3-10
        • Wagner H.
        • Götberg M.
        • Madsen Hardig B.
        • et al.
        Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study.
        BMC Cardiovasc Disord. 2014; 14: 199
        • Jacobs I.
        • Nadkarni V.
        • Bahr J.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).
        Circulation. 2004; 110: 3385-3397
        • Warren S.A.
        • Huszti E.
        • Bradley S.M.
        • et al.
        Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data.
        Resuscitation. 2014; 85: 350-358
        • Becker L.B.
        • Aufderheide T.P.
        • Geocadin R.G.
        • et al.
        Primary outcomes for resuscitation science studies: a consensus statement from the American Heart Association.
        Circulation. 2011; 124: 2158-2177
        • Hastie T.J.
        • Tibshirani R.J.
        Generalized additive models.
        London and New York, Chapman & Hall1990
        • Hamilton L.C.
        Regression with graphics: a second course in applied statistics. Duxbury Press, Belmont, CA1992: 229-233 (158-61)
        • Cairns C.B.
        • Niemann J.T.
        Hemodynamic effects of repeated doses of epinephrine after prolonged cardiac arrest and CPR: preliminary observations in an animal model.
        Resuscitation. 1998; 36: 181-185
        • Insel P.A.
        Seminars in medicine of the Beth Israel Hospital Boston. Adrenergic receptors—evolving concepts and clinical implications.
        N Engl J Med. 1996; 334: 580-585
        • Cantrell Jr., C.L.
        • Hubble M.W.
        • Richards M.E.
        Impact of delayed and infrequent administration of vasopressors on return of spontaneous circulation during out-of-hospital cardiac arrest.
        Prehosp Emerg Care. 2013; 17: 15-22
        • Jain R.
        • Nallamothu B.K.
        • Chan P.S.
        American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) investigators body mass index and survival after in-hospital cardiac arrest.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 490-497
        • Friess S.H.
        • Sutton R.M.
        • Bhalala U.
        • et al.
        Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest.
        Crit Care Med. 2013; 41: 2698-2704
        • Sutton R.M.
        • Friess S.H.
        • Bhalala U.
        • et al.
        Hemodynamic directed CPR improves short-term survival from asphyxia-associated cardiac arrest.
        Resuscitation. 2013; 84: 696-701
        • Sutton R.M.
        • Friess S.H.
        • Naim M.Y.
        • et al.
        Patient-centric blood pressure-targeted cardiopulmonary resuscitation improves survival from cardiac arrest.
        Am J Respir Crit Care Med. 2014; 190: 1255-1262