A prospective observational study on impact of epinephrine administration route on acute myocardial infarction patients with cardiac arrest in the catheterization laboratory (iCPR study)

Critical Care

Research

Ayman Haq¹  Emmanouil S. Brilakis¹  Kristen M. Tecson²  Zemyna Kurnickaite³  Giedre Baksyte³  Ramunas Unikas³  Kasparas Briedis³  Rasa Ordiene³  Karolis Lickunas³  Ali Aldujeli⁴  Vacis Tatarunas⁵  Hussein Khalifeh⁶  Som Bailey⁷  Rima Braukyliene⁸  Anas Hamadeh⁹  Montazar Aldujeili^1,10 

[1] Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;Baylor Scott & White Research Institute, Dallas, TX, USA;Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania;Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania;Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania;Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania;Kreiskrankenhaus Rotenburg, Rotenburg an der Fulda, Germany;Medical City Fort Worth, Fort Worth, TX, USA;Republican Hospital of Panevezys, Panevezys, Lithuania;Texas Cardiovascular Institute, Fort Worth, TX, USA;University of Brescia, Brescia, Italy;

关键词: Intracoronary epinephrine;    Cardiopulmonary resuscitation;    Cardiac arrest;    Acute myocardial infarction;    Stent thrombosis;    Return of spontaneous circulation (ROSC);   

DOI  :  10.1186/s13054-022-04275-8

 received in 2022-10-01, accepted in 2022-12-09,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundEpinephrine is routinely utilized in cardiac arrest; however, it is unclear if the route of administration affects outcomes in acute myocardial infarction patients with cardiac arrest.ObjectivesTo compare the efficacy of epinephrine administered via the peripheral intravenous (IV), central IV, and intracoronary (IC) routes.MethodsProspective two-center pilot cohort study of acute myocardial infarction patients who suffered cardiac arrest in the cardiac catheterization laboratory during percutaneous coronary intervention. We compared the outcomes of patients who received epinephrine via peripheral IV, central IV, or IC.Results158 participants were enrolled, 48 (30.4%), 50 (31.6%), and 60 (38.0%) in the central IV, IC, and peripheral IV arms, respectively. Peripheral IV epinephrine administration route was associated with lower odds of achieving return of spontaneous circulation (ROSC, odds ratio = 0.14, 95% confidence interval = 0.05–0.36, p < 0.0001) compared with central IV and IC administration. (There was no difference between central IV and IC routes; p = 0.9343.) The odds of stent thrombosis were significantly higher with the IC route (IC vs. peripheral IV OR = 4.6, 95% CI = 1.5–14.3, p = 0.0094; IC vs. central IV OR = 6.0, 95% CI = 1.9–19.2, p = 0.0025). Post-ROSC neurologic outcomes were better for central IV and IC routes when compared with peripheral IV.ConclusionEpinephrine administration via central IV and IC routes was associated with a higher rate of ROSC and better neurologic outcomes compared with peripheral IV administration. IC administration was associated with a higher risk of stent thrombosis.Trial registration This trial is registered at NCT05253937.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2022

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