Introduction: International guidelines provide a framework to the epinephrine use within out-of-hospital cardiac arrest (OHCA) care. Despite this consensus, the effectiveness and safety of epinephrine are challenged. The aim of our study is to assess the impact of epinephrine use on the survival rate and neurological outcome on a French population.
Material and methods: Our study was carried out on the French National Cardiac Arrest Registry (RéAC) between July 1st, 2011 and December 31st, 2017. We included 35,431 patients in our study. We adjusted populations using a propensity score matching method. Analyses were separated according to the initial cardiac arrest rhythm.
Results: We created 487 pairs of patients for shockable rhythm and 1,843 for non-shockable rhythm. On shockable rhythms, use of epinephrine was associated with a significantly worsen outcome on all outcomes (ROSC: OR=0.216 [0.165;0.283], D0 survival: OR=0.377 [0.282;0.504], D30 survival: OR=0.216 [0.165;0.283] and D30 CPC1-2: OR=0.478 [0.248;0.921]). On non-shockable rhythms, epinephrine use was associated with a higher rate of ROSC and D0 survival (respectively OR=1.889 [1.608;2.219] and OR=1.703 [1.439;2.015]). However, 30 days after OHCA, epinephrine use was associated with a lower survival and good neurological prognosis rate (respectively OR=0.285 [0.199;0.409] and OR=0.149 [0.061;0.359]).
Conclusion: Epinephrine use was associated with a higher rate of ROSC but no benefit in 30 days survival in non-shockable initial rhythm patients. However, in shockable rhythm, our results tend to show deleterious effects of epinephrine use in all endpoints in OHCA patients care. These results highlight the need of carrying further studies on this issue. For example, the question of the epinephrine posology and/or its association with a betablocker might be investigated before killing (or not) definitively epinephrine.