• Justin Wade Tenney, Jessica Hiu Yan Yip, Roy Hong Yuen Lee, Billy Cheuk Yin Wong, Kevin Kei Ching Hung, LamRex Pui KinRPKPamela Youde Nethersole Eastern Hospital, Hong Kong; The University of Hong Kong, Hong Kong., Daniel Kin Wa Wong, and Wai Tat Wong.
• Prince of Wales Hospital, Lui Che Woo Clinical Sciences Building, Hong Kong; The Chinese University of Hong Kong, Hong Kong. Electronic address: jtenney@westcoastuniversity.edu.
• J Cardiol. 2020 Jul 1; 76 (1): 9-13.

BackgroundEarly medication administration in cardiac arrest improves outcomes. The primary objective was to evaluate the association between epinephrine administration in in-hospital cardiac arrest (IHCA) patients with non-shockable rhythm and the patient outcomes. The secondary objective was to assess the compliance of epinephrine and amiodarone administration in accordance with the advanced cardiovascular life support (ACLS) guideline.MethodsIHCA patients aged 18 years or above were identified from the resuscitation registry of 2016 of two public hospitals and categorized according to their initial rhythms. For patients with non-shockable rhythms, the associations between IHCA outcomes, return of spontaneous circulation (ROSC), and survival to discharge, and the time of epinephrine administration were analyzed by logistic regression. The compliance rate of epinephrine and amiodarone administration during resuscitation to ACLS guideline were reported.ResultsAmong 349 patients with non-shockable rhythm, the median time to epinephrine administration was 3 min (interquartile range, 1-6 min). Early epinephrine administration (<5 min), compared with late epinephrine administration (>5 min), was significantly associated with the rate of ROSC (49.2% vs 34.9%; adjusted odds ratio, 1.630; 95% confidence interval 1.008-2.635, p = 0.046). The time to epinephrine administration (as continuous interval) was significantly associated with the rate of ROSC (p = 0.002) and survival to discharge (p = 0.029). In addition, the compliance rate of epinephrine and amiodarone administration during resuscitation were 83.6% and 33.3%, respectively.ConclusionOur study found that time of epinephrine administration was significantly associated with better results in ROSC and survival to discharge in IHCA patients with non-shockable rhythm. When we divided the IHCA patients with non-shockable rhythms into early and late administration group, early epinephrine administration was associated with significantly improved ROSC, but not survival to discharge after adjusting with potential confounding factors.Copyright © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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