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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

Background

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.

Objective

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.

Methods

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).

Results

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.

Conclusion

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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Keywords

  • Public Health
  • Beneficial Effect
  • Emergency Department
  • Epinephrine
  • Emergency Medicine