Resuscitation That's (Un)Shockable: Time to Get the Adrenaline Flowing

Inpatients who experience nonshockable cardiac arrest are more likely to survive when epinephrine is administered early.

A large and increasing percentage of patients with cardiac arrests exhibit initial nonshockable rhythms (asystole or pulseless electrical activity [PEA]; 82% in 2009 vs. 69% in 2000; NEJM JW Hosp Med Nov 14 2012). Cardiac arrest guidelines recommend early use of epinephrine to manage patients with nonshockable rhythms (Circulation 2010; 122:S729), but this recommendation lacks strong evidence to support efficacy.

Investigators retrospectively evaluated more than 25,000 patients (at 570 U.S. hospitals) with in-hospital cardiac arrests who were not in intensive care units or emergency departments and who exhibited initial rhythms of asystole or PEA. Half of patients received their first dose of epinephrine >3 minutes following the start of res…

Reviewing Author

Daniel D. Dressler, MD, MSc, SFHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, SFHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Resuscitation That's (Un)Shockable: Time to Get the Adrenaline Flowing

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Reviewing Author