Intracoronary epinephrine may best IV delivery for in-hospital cardiac arrest
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Intracoronary epinephrine improved survival, return of spontaneous circulation and neurological outcomes vs. IV epinephrine for cardiac arrest during cardiac catheterization, researchers reported.
“The response time to in-hospital cardiac arrest is generally shorter than out-of-hospital arrest, as the arrests are frequently witnessed, leading to a reduced ischemic burden time (ie, the time between the onset of the arrest and return of spontaneous circulation). Literature indicates that around 3% of in-hospital cardiac arrests occur in the cath lab, and 1.3% of patients who undergo cardiac catheterization experience a cardiac arrest,” Mahmoud Tantawy, MD, of the department of cardiology at Misr University for Science and Technology in Cairo, and colleagues wrote. “Advanced Cardiovascular Life Support guidelines recommend IV and intraosseous epinephrine as a basic cornerstone in the resuscitation process. Data about the efficacy and safety of intracoronary (IC) epinephrine during cardiac arrest in the catheterization laboratory is lacking.”
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Tantawy and colleagues conducted a prospective observational study that included 162 patients (mean age, 60.69 years; 34.6% women) who experienced cardiac arrest while undergoing cardiac catheterization at two tertiary centers in Egypt between 2015 and July 2022. Patients were stratified by route of epinephrine administration: IV or IC.
The primary outcome was survival to discharge. Secondary outcomes included rate of return of spontaneous circulation, time-to-return of spontaneous circulation and favorable neurological outcome defined as modified Rankin Scale score less than 3.
The results were published in European Heart Journal – Quality of Care and Clinical Outcomes.
Fifty-two patients who experienced cardiac arrest while undergoing cardiac catheterization received IC epinephrine, and 110 received IV epinephrine.
Researchers observed that survival to hospital discharge was higher among patients who received IC epinephrine compared with those who received IV epinephrine (84.62% vs. 53.64%; P < .001).
The rate of return of spontaneous circulation also higher among patients who received IC epinephrine (94.23% vs. 63.64%%; P < .001) and was achieved in a shorter time (2.6 vs. 6.8 minutes; P < .0001) compared with patients who received IV epinephrine, according to the study.
In addition, favorable neurological outcomes were more prevalent among those who received IC compared with IV epinephrine (76.92% vs. 47.27%; P < .001).
“The higher rates of return of spontaneous circulation, and shorter time-to-return of spontaneous circulation observed in this study could be attributed to the differences in the pharmacokinetics of epinephrine when administered by the IC vs. the IV routes, where epinephrine delivered via IC pathway is more likely to attain peak concentrations in a shorter time than via IV approach,” the researchers wrote. “This could be the underlying mechanism accounting for the differences in clinical outcomes between both groups.”
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Tantawy M, et al. Eur Heart J Qual Care Clin Outcomes. 2023;doi:10.1093/ehjqcco/qcad013/7040566.
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