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Implementation of the new European Resuscitation Council guidelines regarding epinephrine administration during out-of-hospital cardiopulmonary and cerebral resuscitation, and its effect on the outcome of the patients
Critical Care volume 10, Article number: P383 (2006)
Epinephrine has been used in cardiopulmonary and cerebral resuscitation (CPCR) procedures since the end of the nineteenth century. Since the 1960s an epinephrine dose of 1 mg up to 5 mg, every 5 min, was recommended. According to the current international guidelines from the European Resuscitation Council (ERC), only 1 mg every 3–5 min should be administered and hereby discourage administration of high doses of epinephrine.
To investigate the implementation of the new guidelines for CPCR, in the out-of-hospital setting, regarding the administration of the standard dose of 1 mg epinephrine during resuscitation, and its influence on the outcome of the patients.
A consecutive and prospective study over a period of 5.5 years (1 January 1999–9 July 2004) was conducted. The patients were treated by the MICU of the Academic Hospital of the Vrije Universiteit Brussel (AZ-VUB) onsite and later on in the Emergency Department (ED).
Correct implementation of the new ERC guidelines regarding epinephrine administration during resuscitation was seen in 564 (58.39%) of 966 patients. In 402 (41.61%) patients an excessive dose of epinephrine (EDE), relative to CPCR duration, was given. From those 564 (58.39%) patients where the guidelines were correctly implemented, 180 (31.91%) achieved ROSC, 337 (59.75%) died on the scene, and 47 (8.33%) were still being resuscitated during their transport to the ED. From the 402 (41.61%) patients where the guidelines were not properly implemented, 90 (22.39%) patients achieved ROSC, while 290 (72.14%) patients were declared dead. In 22 (5.47%) patients, CPCR was continued up to the ED. Evaluation of the LTO in patients that received a guideline-respected dose of epinephrine revealed that: 93 (58.49%) patients were still alive 1 year after resuscitation, and 32 (41.51%) were dead. For those whom received an EDE, relative to CPCR duration, 180 (60.00%) survived and 32 (40.00%) died 1 year after resuscitation.
There is a lack of adherence to the current guidelines regarding epinephrine administration during CPCR. Moreover, 1 mg epinephrine each 3–5 min seems to increase the percentage of ROSC, but unfortunately this beneficial effect disappears 1 year after the insult.
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Flamee, P., Hachimi-Idrissi, S. Implementation of the new European Resuscitation Council guidelines regarding epinephrine administration during out-of-hospital cardiopulmonary and cerebral resuscitation, and its effect on the outcome of the patients. Crit Care 10, P383 (2006). https://doi.org/10.1186/cc4730
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