Epinephrine May Not be Safe for Patients with Cardiac Arrest
Epinephrine, which is often administered to cardiac arrest patients to aid in restarting the heart, may not be safe, a new study found. According to the researchers, epinephrine can increase patients' overall risk of death and brain damage.
Epinephrine, which is also called adrenaline, stimulates the heart by promoting blood flow. Current international guidelines recommend the use of one milligram of epinephrine per every three to five minutes during resuscitation.
In this study, researchers examined the safety of using epinephrine. They analyzed hospital medical records on more than 1,500 patients who suffered an out-of-hospital cardiac arrest and were being treated at a Parisian hospital. Almost 75 percent of the patients received at least one dose of epinephrine.
The team compared patients' brain functioning levels at discharge and discovered that 63 percent of patients who were not treated with epinephrine had normal or moderately compromised brain functioning. In the epinephrine-treated group, however, only 19 percent of them had similar brain outcomes. In the epinephrine group, patients who received higher doses had worst outcomes in comparison to those who were given a lower dose.
Overall, patients who were treated with one milligram of epinephrine were 52 percent more likely to have a bad outcome in comparison to patients who did not receive epinephrine. Patients who were treated with a five-milligram dose were 77 percent more likely to have a bad outcome.
"The role of epinephrine is more and more questionable in cardiac arrest," said the study's lead author Florence Dumas, M.D., Ph.D., of the Parisian Cardiovascular Research Center in France. "We need to constantly assess our procedures and protocols to make sure that the use of epinephrine is effective and done at the correct time."
The researchers noted that timing played a huge factor as well. Patients who received epinephrine during the later stages of resuscitation had a greater risk of death in comparison to patients who received it immediately after cardiac arrest.
"It's very difficult, because epinephrine at a low dose seems to have a good impact in the first few minutes, but appears more harmful if used later," said Dumas according to the press release. "It would be dangerous to completely incriminate this drug, because it may well be helpful for certain patients under certain circumstances. This is one more study that points strongly to the need to study epinephrine further in animals and in randomized trials."
The study was published in the Journal of the American College of Cardiology.