• Andrew D Straznitskas, Sylvia Wong, Nicole Kupchik, and David Carlbom.
• Andrew D. Straznitskas is a pharmacist at Bellevue Hospital Center, New York, New York. Sylvia Wong is a pharmacist at Harborview Medical Center, University of Washington Medicine, Seattle, Washington. Nicole Kupchik is an independent clinical nurse specialist and staff nurse at Swedish Medical Center, Seattle, Washington. David Carlbom is director of the paramedic training program and an associate professor of medicine, pulmonary critical care at Harborview Medical Center, University of Washington Medicine. andrew.straznitskas@bellevue.nychhc.org.
• Am. J. Crit. Care. 2015 May 1;24(3):e22-7.

BackgroundDevelopment of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality.ObjectiveTo examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not.MethodsData were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls). Dosing of epinephrine during cardiac arrest and other variables were compared between cases and controls.ResultsOf the 215 patients identified with an initial rhythm of pulseless electrical activity or asystole, 51 (23.7%) had a secondary ventricular fibrillation or ventricular tachycardia develop. Throughout the total duration of arrest, including periods of return of spontaneous circulation, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.4 minutes compared with 1 mg every 5 minutes in controls (P= .001). For the total duration of pulselessness, excluding periods of return of spontaneous circulation during the arrest, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.1 minutes versus 1 mg every 4.3 minutes in controls (P= .001).ConclusionMore frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia.©2015 American Association of Critical-Care Nurses.

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