Epinephrine in Out of Hospital Cardiac Arrest
This month is our July kickoff and JC welcomes our new PGY-1’s, PA fellows, EM destined medical students and new EPT attendings physicians and PA’s. The use of epinephrine in the out-of-hospital cardiac arrest (OHCA) victim is recommended in the 2018 AHA recommendations despite a paucity of evidence that the use of epinephrine favorably affects patient-centered outcomes. Those who have been around a while will recall a brief period where we were using high-dose epinephrineas it was shown to improve coronary perfusion pressures and ROSC. Unfortunately, it did not improve survival to hospital discharge or improvement in neurologic outcomes (Paradis,Perondi) and in fact, may worsen cerebral perfusion (Ristagno). Our selected articles include a widely cited large prospective Japanese study from 2012 that included over 400,000 subjects (Hagihara), a recently published article on the time to epinephrine administration (Hansen) and its effect on outcomes and the long awaited prospective British randomized controlled Paramedic-2 trial (Perkins). Finally, what may prove the most interesting article of the night and included in EVERY July’s JC is an instructive article on how to admit patients with no discernible pathology.