• Ali Aldujeli, Ayman Haq, Kristen M Tecson, Zemyna Kurnickaite, Karolis Lickunas, Som Bailey, Vacis Tatarunas, Rima Braukyliene, Giedre Baksyte, Montazar Aldujeili, Hussein Khalifeh, Kasparas Briedis, Rasa Ordiene, Ramunas Unikas, Anas Hamadeh, and Emmanouil S Brilakis.
• Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania. ali.hadi.medicine@hotmail.com.
• Crit Care. 2022 Dec 20; 26 (1): 393393.

BackgroundEpinephrine is routinely utilized in cardiac arrest; however, it is unclear if the route of administration affects outcomes in acute myocardial infarction patients with cardiac arrest.ObjectivesTo compare the efficacy of epinephrine administered via the peripheral intravenous (IV), central IV, and intracoronary (IC) routes.MethodsProspective two-center pilot cohort study of acute myocardial infarction patients who suffered cardiac arrest in the cardiac catheterization laboratory during percutaneous coronary intervention. We compared the outcomes of patients who received epinephrine via peripheral IV, central IV, or IC.Results158 participants were enrolled, 48 (30.4%), 50 (31.6%), and 60 (38.0%) in the central IV, IC, and peripheral IV arms, respectively. Peripheral IV epinephrine administration route was associated with lower odds of achieving return of spontaneous circulation (ROSC, odds ratio = 0.14, 95% confidence interval = 0.05-0.36, p < 0.0001) compared with central IV and IC administration. (There was no difference between central IV and IC routes; p = 0.9343.) The odds of stent thrombosis were significantly higher with the IC route (IC vs. peripheral IV OR = 4.6, 95% CI = 1.5-14.3, p = 0.0094; IC vs. central IV OR = 6.0, 95% CI = 1.9-19.2, p = 0.0025). Post-ROSC neurologic outcomes were better for central IV and IC routes when compared with peripheral IV.ConclusionEpinephrine administration via central IV and IC routes was associated with a higher rate of ROSC and better neurologic outcomes compared with peripheral IV administration. IC administration was associated with a higher risk of stent thrombosis. Trial registration This trial is registered at NCT05253937 .© 2022. The Author(s).

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