Cardiac arrest & resuscitation
Cumulative dose of epinephrine and mode of death after non-shockable out-of-hospital cardiac arrest: a registry-based study
Authors' conclusion
In non-shockable OHCA with ROSC, the dose of epinephrine used during CPR is strongly associated with early cardiocirculatory death.
Study context
- Population
- Adults with return of spontaneous circulation (ROSC) after medical, cardiac and non-cardiac causes, non-shockable out-of-hospital cardiac arrest (OHCA) admitted to an intensive care unit (ICU), Sudden Death Expertise Center registry, Greater Paris, May 2011–December 2021analysed
- Participants
- 2,792 adults
- Exposure
- Cumulative epinephrine dose during cardiopulmonary resuscitation (CPR)
- Survivorsn = 242reference
- Cardiocirculatory deathn = 1,004
- Neurological deathn = 1,233
- Other deathsn = 313
- Outcome
- Mode of ICU death (cardiocirculatory, neurological, or other)
Methodological detailsprospectively collected registry data, multivariable analysis
- Prospectively collected registry data
- Multivariable analysis
Main finding
As reported in the abstract
Cardiocirculatory death by cumulative epinephrine dose
Adjusted odds ratio (95% CI)
1 mg vs 0 mg
3.45(2.01–5.92)
2-5 mg vs 0 mg
12.28(7.52–20.06)
> 5 mg vs 0 mg
23.71(11.02–50.97)
- Proportion of cardiocirculatory death increased linearly with cumulative epinephrine dose (17.7% with no epinephrine; 62.5% with > 10 mg)
- R2 = 0.92, p < 0.001
Observational data: associations, not effects.
Further findings
Epinephrine dose received
- Epinephrine dose received: p < 0.001
Neurological and other modes of death
- Also associated with epinephrine use, but to a lesser extent
Original publication
Cumulative dose of epinephrine and mode of death after non-shockable out-of-hospital cardiac arrest: a registry-based study. Crit Care. Published 20 December 2023. doi:10.
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