CUMULATIVE EPINEPHRINE DOSE DURING CARDIOPULMONARY-RESUSCITATION AND NEUROLOGIC OUTCOME

Background: Epinephrine is the drug of choice in advanced cardiac life support, but it can have deleterious side effects after restoration o f spontaneous circulation. Objective: To investigate the association b etween the cumulative epinephrine dose used in advanced cardiac life s upport and neurologic outcome after cardiac arrest. Design: Retrospect ive cohort study. Setting: University hospital. Patients: Adults admit ted to the emergency department with witnessed, nontraumatic, normothe rmic ventricular fibrillation cardiac arrest and unsuccessful initial defibrillation. Measurements: Functional neurologic outcome was regula rly assessed by cerebral performance category (CPC) within 6 months af ter cardiac arrest. A CPC of 1 or 2 was defined as favorable recovery. Results: Among 178 enrolled patients, the median cumulative epinephri ne dose administered was 4 mg (range, 0 to 50 mg). In 151 patients (84 %), spontaneous circulation was restored; 63 of these 151 patients (42 %) had favorable neurologic recovery. Patients with an unfavorable CPC received a significantly higher cumulative dose of epinephrine than d id patients with a favorable CPC (4 mg compared with 1 mg; P < 0.001). This finding persisted after stratification by duration of resuscitat ion. After possible cofounders were controlled for, the cumulative epi nephrine dose remained an independent predictor of unfavorable neurolo gic outcome. Conclusions: The results indicate that an increasing cumu lative dose of epinephrine administered during resuscitation is indepe ndently associated with unfavorable neurologic outcome after ventricul ar fibrillation cardiac arrest.