Implications of cumulative epinephrine dosage on mortality outcomes after non-shockable out-of-hospital cardiac arrest

Recently published study aimed to assess the association between epinephrine use during cardiopulmonary resuscitation (CPR) and subsequent intensive care unit (ICU) mortality in patients with return of spontaneous circulation (ROSC) after non-shockable out-of-hospital cardiac arrest (OHCA). The study analyzed data from the Sudden Death Expertise Center (SDEC) registry, which included adults with ROSC after non-shockable OHCA admitted to an ICU in the Greater Paris area, France between May 2011 and December 2021. Of the 2,792 patients analyzed, the study found that the cumulative dose of epinephrine used during CPR was strongly associated with cardiocirculatory death. The proportion of cardiocirculatory death increased linearly with cumulative epinephrine doses, with a significant association between high cumulative doses of epinephrine and cardiocirculatory death, even after adjusting for various factors. Additionally, the study suggested that the management after ROSC in the ICU should be adapted to the dose of epinephrine received during CPR, and strategies for preventing and managing post-resuscitation shock and sudden death recurrence should be evaluated in future randomized trials based on the cumulative dose of epinephrine. The study also highlighted the need for future studies aiming to limit the dose of epinephrine during CPR and suggested that therapeutic targets in the post-ROSC management should be adapted to each patient based on the epinephrine dose used during CPR. The findings support the importance of considering the cumulative dose of epinephrine in personalizing post-ROSC management, as it was found to be strongly associated with early cardiocirculatory death in non-shockable OHCA. The study emphasized the potential implications for optimizing therapeutics and personalizing management in the ICU.

Reference –

Javaudin, F., Bougouin, W., Fanet, L. et al. Cumulative dose of epinephrine and mode of death after non-shockable out-of-hospital cardiac arrest: a registry-based study. Crit Care 27, 496 (2023). https://doi.org/10.1186/s13054-023-04776-0.