CARING FOR THE CRITICALLY ILL PATIENT Prehospital EpinephrineUseandSurvivalAmong Patients With Out-of-Hospital Cardiac Arrest

EPINEPHRINE IS WIDELY USED IN cardiopulmonary resuscitation (CPR) for patients with out-of-hospital cardiac arrest (OHCA). However, its effectiveness in CPR has not been established. Epinephrine is associated with increased myocardial oxygen consumption and ventricular arrhythmias during the period after resuscitation. Concern has been raised regarding increased myocardial dysfunction and disturbed cerebral microcirculation after cardiac arrest. Findings in support of epinephrine use include animal studies that show a beneficial short-term effect of epinephrine, and evidence of increased cerebral and coronary perfusion by redirected peripheral blood flow has been reported. To verify the effectiveness of epinephrine in CPR, the influences of other factors, such as patients, bystanders, CPR by bystanders, life support by emergency medical service (EMS) personnel, and time from call to the scene or hospital arrival, need to be controlled. To control for the effects of covariates, a randomized controlled trial needs to be performed. However, such a study is not easily performed because of ethical reasons.