JJ 14 Epinephrine in Cardiac Arrest

Journal Jam 14 - Epinephrine in Cardiac Arrest on EM Cases At the 2018 Resuscitation in Motion conference in Toronto I interviewed four of the world’s leading researchers in Cardiac Arrest. Among other topics I asked them their opinions on the  timing, dose, specific indications and evidence for epinephrine in cardiac arrest. No surprise, there wasn’t any consensus on whether or not to use epinephrine during cardiac arrest in the first place. There wasn't any consensus on timing or dosage either - except maybe the earlier, the better. There wasn’t any consensus on which patients are most likely to benefit from epinephrine. Some cited papers showing higher doses and earlier administration of epinephrine in cardiac arrest increasing ROSC rates, while others cited papers showing lower doses improving cerebral perfusion pressure. There was talk about titrating epinephrine in cardiac arrest to diastolic blood pressure from an arterial line, which some docs have apparently adopted in their practice. There was also talk of titrating to infrared spectroscopy cerebral oxygenation, which sounds promising, but has a whole slew of practical problems and no promising outcome data. The already famous PARAMEDIC2 trial was published after the Resuscitation in Motion conference and sparked controversy throughout the emergency medicine community. Does PARAMEDIC2 bring us any closer to answering the questions that I posed the world's leading researchers in cardiac arrest? The big questions is: Does epinephrine improve the chances of return of spontaneous circulation at the expense of the brain? In other words, while we know that epinephrine doubles rates of ROSC in all comers in cardiac arrest, there’s never been robust evidence for long term improvements in neurologic functional outcomes. Are we saving lives, or are we prolonging death? Find out the answer in this Journal Jam podcast with Justin Morgenstern and Rory Spiegel as we dive deep into the worlds literature on epinephrine in cardiac arrest... Podcast production by Anton Helman, Justin Morgenstern & Rory Spiegel. Editing and sound design by Anton Helman. Blog post by Anton Helman Cite this podcast as: Helman, A, Morgenstern, J, Spiegel, R. Epinephrine in Cardiac Arrest. Emergency Medicine Cases. November, 2018. https://emergencymedicinecases.com/epinephrine-cardiac-arrest/. Accessed [date]. References for this Journal Jam podcast on Epinephrine in Cardiac Arrest PARAMEDIC2 Perkins GD, Ji C, Deakin CD, et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. The New England journal of medicine. 2018; 379:711-721. Expand to view reference list Stiell IG, Hebert PC, Weitzman BN, et al. High-dose epinephrine in adult cardiac arrest. The New England journal of medicine. 1992; 327(15):1045-50. Brown CG, Martin DR, Pepe PE, et al. A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. The New England journal of medicine. 1992; 327(15):1051-5. Callaham M, Madsen CD, Barton CW, Saunders CE, Pointer J. A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest. JAMA. 1992; 268(19):2667-72. Holmberg M, Holmberg S, Herlitz J. Low chance of survival among patients requiring adrenaline (epinephrine) or intubation after out-of-hospital cardiac arrest in Sweden. Resuscitation. 2002; 54(1):37-45. Perondi MB, Reis AG, Paiva EF, Nadkarni VM, Berg RA. A comparison of high-dose and standard-dose epinephrine in ...