Epinephrine and Cerebral Blood Flow in Cardiac Arrest
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Jon-Emile S. Kenny MD [@heart_lung] “I am a necessary part of an important search to which there is no end.” -Keith Haring Background With PARAMEDIC-2, the role of epinephrine in cardiac arrest, and especially its effects on cerebral perfusion and neurological outcome, have been appropriately questioned. Recall that Perkins and colleagues studied epinephrine in out-of-hospital cardiac arrest in a very well-performed randomized controlled trial of over 8000 patients. Epinephrine significantly improved 30-day survival with a number needed to treat of 112. Importantly, however, about 1/3rd of the survivors in the epinephrine group did so with modified Rankin scores of 4 or 5 – indicating severe neurological disability; only 17% in the placebo group survived with comparably poor neurological outcome. Accordingly, there is fear that epinephrine improves central hemodynamics but vitiates neurological perfusion. Amplifying this concern is data published by
Epinephrine and Cerebral Blood Flow in Cardiac Arrest
Epinephrine and Cerebral Blood Flow in…
Epinephrine and Cerebral Blood Flow in Cardiac Arrest
Jon-Emile S. Kenny MD [@heart_lung] “I am a necessary part of an important search to which there is no end.” -Keith Haring Background With PARAMEDIC-2, the role of epinephrine in cardiac arrest, and especially its effects on cerebral perfusion and neurological outcome, have been appropriately questioned. Recall that Perkins and colleagues studied epinephrine in out-of-hospital cardiac arrest in a very well-performed randomized controlled trial of over 8000 patients. Epinephrine significantly improved 30-day survival with a number needed to treat of 112. Importantly, however, about 1/3rd of the survivors in the epinephrine group did so with modified Rankin scores of 4 or 5 – indicating severe neurological disability; only 17% in the placebo group survived with comparably poor neurological outcome. Accordingly, there is fear that epinephrine improves central hemodynamics but vitiates neurological perfusion. Amplifying this concern is data published by