Intracoronary epinephrine during cardiac resuscitation for patients undergoing percutaneous coronary intervention for acute myocardial infarction (iCPR study)

Abstract Background Despite significant progress in cardiopulmonary resuscitation (CPR), outcomes remain relatively poor. Epinephrine administration remains a cornerstone the treatment of in-hospital cardiac arrest. Various routes administration, including intravenous, intramuscular, intraosseous and endotracheal have been studied; however, optimal route is debated. Purpose The purpose this study was to compare patient following peripheral intravenous (IV), central IV, or arterial intracoronary (IC) epinephrine patients undergoing CPR catheterization laboratory. Methods This prospective two-center pilot cohort conducted high-volume percutaneous coronary intervention (PCI) facilities republic Lithuania. enrolled with acute myocardial infarction (AMI) who suffered arrest laboratory during PCI. Cardiac performed according European Resuscitation Council Guidelines. Central IV first choice for if it available. However, cases without access, (peripheral IC) at discretion physician. primary endpoint rate return spontaneous circulation (ROSC). We tested overall differences characteristics between groups using Chi-Square (or Kruskal-Wallis) tests used Holm-Bonferroni adjustment Dunn's tests) subsequent pairwise tests. also logistic regression. Results There were 158 participants study, 48 (30.4%), 50 (31.6%), 60 (38.0%) receiving via IC, routes, respectively. median age 71 [61, 80] years 56% men. Patient similar across except (higher than IC), serum potassium (although no post-hoc differences), hemoglobin (lowest route), heart rhythm before rates electromechanical dissociation route). 111 (70%) achieved outcome ROSC (Table 1). Peripheral associated 7-fold decreased odds achieving (odds ratio = 0.14, 95% confidence interval 0.05–0.36, p<0.0001) compared (no difference IC; p=0.9343). By itself, adrenaline yielded an area under receiver operating characteristic curve 0.73, indicating good predictive ability. Conclusion predictor AMI received IC superior those IV. Funding Acknowledgement Type funding sources: Foundation. Main source(s): Baylor Health Care System Foundation (USA)National Interventional Cardiology Association (Lithuania)