Time to Epi for Non-Shockable Rhythm Matters

June 7, 2018

Written by Clay Smith

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Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

Why does this matter?
The literature has been back and forth on epinephrine in arrest.  A study says sooner is better.  But another study says not too soon.  Yet another says we may be giving it too frequently.  What about the cohort of patients with non-shockable rhythms?  Does timely epinephrine matter?

Sooner was better
This was a registry study from the Resuscitation Outcomes Consortium network that included out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm.  There were 32,101 patients included.  For every minute delay in epi administration, there was a 4% decrease in odds of survival to discharge, in both children and adults.  Not all patients had neurological status at discharge recorded.  For the 13,290 who had modified Rankin score assessment, odds of survival with modified Rankin Scale <3 (slight disability or better) were reduced 6% for each minute epi was delayed.  In this large, retrospective study, it appears earlier epi administration for non-shockable rhythm was associated with better overall survival and neurologically intact survival.  Any way we can reduce EMS arrival time, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

Source
Time to Epinephrine Administration and Survival From Nonshockable Out-of-Hospital Cardiac Arrest Among Children and Adults.  Circulation. 2018 May 8;137(19):2032-2040. doi: 10.1161/CIRCULATIONAHA.117.033067. Epub 2018 Mar 6.

Peer reviewed by Thomas Davis