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{
    "pk": 18107,
    "title": "Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation",
    "subtitle": null,
    "abstract": "Introduction:\n Epinephrine continues to be a fundamental part of the Advanced Cardiac Life Support algorithm despite a lack of evidence that it improves neurologically intact survival. Our aim was both to identify a potential upper limit of epinephrine use in resuscitations and to demonstrate real-world epinephrine use in different patient subgroups.\nMethods:\n This was a single-center, retrospective cohort study, conducted between August 1, 2016–July 1, 2021, of patients with medical cardiac arrest who were administered a known number of epinephrine doses. The primary outcome was neurologically intact discharge defined by a modified Rankin scale ≤3, with secondary outcomes of comparing epinephrine doses by age, rhythm, and emergency medical services vs emergency department administration of epinephrine.\nResults: \nThe study included 1,330 patients, with 184 patients (13.8%) surviving to neurologically intact discharge. The primary outcome of neurologically intact discharge was found in 89 (65.4%) patients in the zero epinephrine dose group, 75 (20.0%) in the 1-3 dose group, 15 (4.3%) in the 4-6 dose group, and one (0.002%) in the ≥7 dose group (P < 0.001). Patients received similar amounts of epinephrine when stratified by age, while patients with shockable rhythms received more epinephrine than patients with non-shockable rhythms.\nConclusion:\n There was a significant decrease in neurologically intact discharge with increasing number of epinephrine doses, and our data suggests that seven or more doses of epinephrine is almost always futile. While further prospective studies are needed, clinicians should consider epinephrine doses when weighing the futility or benefit of continued resuscitation efforts.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Epinephrine"
        },
        {
            "word": "cardiac arrest"
        },
        {
            "word": "emergency medical services"
        },
        {
            "word": "EMS"
        },
        {
            "word": "resuscitation"
        }
    ],
    "section": "Cardiology",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/656854c1",
    "frozenauthors": [
        {
            "first_name": "Zachary",
            "middle_name": "",
            "last_name": "Boivin",
            "name_suffix": "",
            "institution": "University of Connecticut, Emergency Medicine Residency, Farmington, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Kevin",
            "middle_name": "M.",
            "last_name": "Duignan",
            "name_suffix": "",
            "institution": "University of Connecticut, Emergency Medicine Residency, Farmington, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Donias",
            "middle_name": "",
            "last_name": "Doko",
            "name_suffix": "",
            "institution": "University of Connecticut, Emergency Medicine Residency, Farmington, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Nicholas",
            "middle_name": "",
            "last_name": "Pugliese",
            "name_suffix": "",
            "institution": "Cooper University Hospital, Department of Pharmacy, Camden, New Jersey",
            "department": "None"
        },
        {
            "first_name": "Trent",
            "middle_name": "",
            "last_name": "She",
            "name_suffix": "",
            "institution": "Hartford Hospital, Department of Emergency Medicine, Hartford, Connecticut",
            "department": "None"
        }
    ],
    "date_submitted": "2023-04-30T21:15:02+01:00",
    "date_accepted": "2023-04-30T21:15:02+01:00",
    "date_published": "2023-11-08T20:47:43Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/18107/galley/9230/download/"
        }
    ]
}