Starting off the news for EMS providers this week, we look at an article in the Journal of American College of Cardiology. We have long given certain drugs for certain conditions based on the assumptions that it might help with treatment.
Epinephrine Use Called Into Question
In recent years, though, the advent of evidence based medicine has started to change that paradigm. One of the last hold-outs has been the routine use of epinephrine on cardiac arrest patients. Many have had concerns that using a drug that has such a strong effect on cardiac work load could be harmful to cardiac arrest patients experiencing myocardial infarction.
A recent journal article about a study in to the use of epinephrine in cardiac arrest is supporting that concern. The study looked at 1500 cardiac arrest patients over 12 years all of whom achieved successful return of spontaneous circulation or ROSC. The goal was to see what might affect their chances to survive to discharge from the hospital.
Lower Survival To Discharge
73% of the patients received epinephrine with a survival to discharge rate of 17%. This is compared to a survival rate of over 63% for the non-epinephrine patient group. The study also found that the more epinephrine that was given over the resuscitation effort, the poorer the outcomes were.
The authors call for additional studies but my guess is the routine use of epinephrine in cardiac arrest patients is not long for this world. The question I have is how long will it take this research to filter down to the protocols you and I use to treat patients. Sometimes these things take years to take effect.
Let’s hope it doesn’t take that long. In the mean time, make sure you are following your own protocols. Only doctors can make the call to use or not use medications outside of accepted practice. Don’t put yourself or your license at risk doing things not approved by your medical director.
Follow up on the links to this news item and all the other articles and resources in this week’s episode show notes – 2015 Managing Special Needs Patients and MedicCast Episode 415.