Journal Club
February 2010 Emergency Medicine Journal Club Vignette

While working in the ED, paramedics bring in a 75 year old male with a witnessed cardiac arrest. Per the medics, the patient collapsed at home. When the medics arrived, the patient was found to be in ventricular fibrillation, CPR was initiated and the patient was defibrillated and given Epinephrine, and is now in Asystole. In the ED, despite additional rounds of Epinephrine, the patient expires in the ED. Later in the evening, a similar patient encounter with a 70 year old female occurs with the same outcome. The astute ED physician, realizing that it has been embedded in his training about the need for Epinephrine, reflects on these patient encounters on the ride home from work and begins to wonder about the utility of Epinephrine in those patients with an out of hospital cardiac arrest. He realizes it is part of the ACLS training but is not certain of the evidence for or against the use of it.

To investigate this, the following approach is explored:

PICO Question

Population: Adult patients with out of hospital cardiac arrest
Intervention: Epinephrine use
Comparison: No Epinephrine
Outcome: Improved Outcomes (ROSC, Survival to Admission, Survival to Hospital Discharge)


Search Strategy: Pubmed; Keywords: heart arrest AND epinephrine AND cardiopulmonary resuscitation
Limits: English, Last 10 years, adults, humans. 112 citations found, of which the following three are selected after abstract review:
First years: Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest. Ann Emer Med 2007; 50: 635-642.

Article critique
Second years: Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest. Resuscitation 2005; 67: 69-74.

Article critique
Third years: Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA 2009; 302: 2222-2229.

Article critique
1st & 2nd years use the "Observational Study Critical Review Form" (Download)
3rd years use the "RCT Therapy Critical Review Form" (Download)
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