Following up on the most recently published prehospital trials, we’re going back to an article published a few months ago. We’ve seen the data regarding epinephrine versus placebo – some does something, nothing does nothing, but the benefit of either strategy is debatable. Is there a better way?
This little retrospective report looks at the middle ground – a “well, let’s try and give a little less” protocol implemented in the King County prehospital system. Moving from their original protocol based on 1mg dosing with intervals indicated by rhythm, they halved it to 0.5mg. This resulted in patients generally getting a mean dose of epinephrine of about 2.5-3mg per arrest, rather than the 3.5-4mg total prior to implementation.
Did any outcome – survival, or, more importantly, neurologically-intact
survival – change? Not reliably, no.
These data provide only the lowest level of evidence as applied to determining the most advantageous use of epinephrine in the prehospital setting. This neither confirms nor refutes the premise of their practice change, and provides little specific insight into where the serial dilution of epinephrine loses its potency. There may yet be a sweet spot where return of spontaneous circulation occurs with minimal collateral damage, but we’ll need to wait for future research to provide additional data.
“Lower-dose epinephrine administration and out-of-hospital cardiac arrest outcomes”
https://www.ncbi.nlm.nih.gov/pubmed/29305926