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Previous Volume 339:1595-1601 November 26, 1998 Number 22 Next

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ABSTRACT

Background Clinical trials have not shown a benefit of high doses of epinephrine in the management of cardiac arrest. We conducted a prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest.

Methods Adult patients who had cardiac arrest outside the hospital were enrolled if the cardiac rhythm continued to be ventricular fibrillation despite the administration of external electrical shocks, or if they had asystole or pulseless electrical activity at the time epinephrine was administered. We randomly assigned 3327 patients to receive up to 15 high doses (5 mg each) or standard doses (1 mg each) of epinephrine according to the current protocol for advanced cardiac life support.

Results In the high-dose group, 40.4 percent of 1677 patients had a return of spontaneous circulation, as compared with 36.4 percent of 1650 patients in the standard-dose group (P=0.02); 26.5 percent of the patients in the high-dose group and 23.6 percent of those in the standard-dose group survived to be admitted to the hospital (P=0.05); 2.3 percent of the patients in the high-dose group and 2.8 percent in the standard-dose group survived to be discharged from the hospital (P=0.34). There was no significant difference in neurologic status according to treatment among those discharged. High-dose epinephrine improved the rate of successful resuscitation in patients with asystole, but not in those with ventricular fibrillation.

Conclusions In our study, long-term survival after cardiac arrest outside the hospital was no better with repeated high doses of epinephrine than with repeated standard doses.

Source Information

From the Department of Anesthesiology and Emergency Medical System, Service d'Aide Médicale Urgente of Lyons, Edouard Herriot Hospital, Claude Bernard University, Lyons, France (P.-Y.G., P.-Y.D., P.P.); the Department of Emergency Medicine and Emergency Medical System, Service d'Aide Médicale Urgente of Brussels, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium (P.M.); the Department of Anesthesiology and Emergency Medical System, Service d'Aide Médicale Urgente of Lille, Centre Hospitalier Régional et Universitaire of Lille, Lille, France (P.G.); the Department of Computers and Statistics, Medical Service, Claude Bernard University, Lyons, France (E.P.); the Pharmaceutical Department, Edouard Herriot Hospital, Lyons, France (C.D.); the Department of Emergency Medicine, Service Mobile d'Urgence et de Réanimation of the Centre Hospitalier Régional Citadelle, Liege, Belgium (M.V.); and the Department of Anesthesiology and Emergency Medical System, Service d'Aide Médicale Urgente of Paris, Centre Hospitalier Universitaire Necker, Paris (P.C.).

Address reprint requests to Dr. Gueugniaud at the Department of Anesthesiology VII, Pavillon I, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyons CEDEX 03, France.

Full Text of this Article

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Epinephrine for Out-of-Hospital Cardiac Arrest
Bakker J., Rommes H., Martens P. R., Gueugniaud P.-Y., Mols P., Pannetier J.-C.
Extract | Full Text  
N Engl J Med 1999; 340:1763-1765, Jun 3, 1999. Correspondence

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