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Endotracheal versus Intravenous Epinephrine in the Prehospital Treatment of Cardiac Arrest

Published online by Cambridge University Press:  28 June 2012

Sandra M. Schneider ,
Donald M. Yealy ,
Edward A. Michaelson ,
Thomas R. Kearns  and
Paul M. Paris
Sandra M. Schneider*
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA The Division of Medical Emergency Services, Montefiore Hospital of Pittsburgh, USA
Donald M. Yealy
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA The Darnall Army Community Hospital, Fort Hood, TX., USA
Edward A. Michaelson
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA The Division of Medical Emergency Services, Montefiore Hospital of Pittsburgh, USA
Thomas R. Kearns
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA
Paul M. Paris
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA Department of Public Safety, Bureau of Emergency Medical Services, City of Pittsburgh, PA, USA
*
Sandra M. Schneider, MD, EMS, Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA 15213
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Abstract

We performed a retrospective review of the charts of 252 adult, non-traumatic, prehospital cardiac arrest patients treated over a one-year period in order to assess the effectiveness of intravenous (IV) and endotracheal (ET) administration of epinephrine (0.5–1.0 mg) (EPI) in assisting restoration of a spontaneous pulse. Patients initially receiving IV-EPI were more likely to develop a spontaneous pulse earlier than those receiving a similar dose ET (7.3% vs 0.9%; p<0.01. In those patients who received a second dose of EPI, six (2.9%) regained a spontaneous pulse; each had been treated previously with IV-EPI. None who required a third dose of EPI regained a spontaneous pulse. In total, only five (2%) patients survived to discharge. We conclude that, in our system, patients who receive the currently recommended dose of EPI to treat cardiac arrest have a poor prognosis, and that IV-EPI is associated with a higher incidence of return of a spontaneous pulse compared to those treated ET.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 5 , Issue 4 , December 1990 , pp. 341 - 348
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1990

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