• Andrew Baird, Patrick J Coppler, Clifton W Callaway, Cameron Dezfulian, Katharyn L Flickinger, Jonathan Elmer, and University of Pittsburgh Post-Cardiac Arrest Service.
• Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
• Resuscitation. 2020 Nov 1; 156: 15-18.

IntroductionData supporting epinephrine administration during resuscitation of in-hospital cardiac arrest (IHCA) are limited. We hypothesized that more frequent epinephrine administration would predict greater early end-organ dysfunction and worse outcomes after IHCA.MethodsWe performed a retrospective cohort study including patients resuscitated from IHCA at one of 67 hospitals between 2010 and 2019 who were ultimately cared for at a single tertiary care hospital. Our primary exposure of interest was rate of intra-arrest epinephrine bolus administration (mg/min). We considered several outcomes, including severity of early cardiovascular failure (modeled using Sequential Organ Failure Assessment (SOFA) cardiovascular subscore), early neurological and early global illness severity injury (modeled as Pittsburgh Cardiac Arrest Category (PCAC)). We used generalized linear models to test for independent associations between rate of epinephrine administration and outcomes.ResultsWe included 695 eligible patients. Mean age was 62 ± 15 years, 416 (60%) were male and 172 (26%) had an initial shockable rhythm. Median arrest duration was 16 [IQR 9-25] min, and median rate of epinephrine administration was 0.2 [IQR 0.1-0.3] mg/min. Higher rate of epinephrine predicted worse PCAC, and lower survival in patients with initial shockable rhythms. There was no association between rate of epinephrine and other outcomes.ConclusionHigher rates of epinephrine administration during IHCA are associated with more severe early global illness severity.Copyright © 2020 Elsevier B.V. All rights reserved.

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