Category: Cardiac arrest

Defibrillation is often considered ineffective in hypothermic cardiac arrest patients with shockable rhythms, particularly at core temperatures ≤30 °C, and the optimal timing and number of shocks as well as the role of rewarming have remained uncertain. However, a retrospective observational study published in Resuscitation showed that defibrillation attempts can be successful even before rewarming […]

A pre-post study conducted in North Carolina compared multi-dose epinephrine with single-dose epinephrine in adult non-traumatic out-of-hospital cardiac arrest (OHCA) patients. The authors concluded that patients with bystander CPR and a shockable rhythm who received only a single dose of epinephrine had a higher survival rate to hospital discharge compared to those who did not […]

I personally believe that having a secure line, whether a peripheral IV or central line, is essential for resuscitating a patient. However, this is just my opinion. A recent article in NEJM highlighted that the drug administration route—IV versus IO—matters in terms of successful resuscitation, return of spontaneous circulation (ROSC), and favorable neurological outcomes. Link […]

Epinephrine and cardiac arrest: what’s the question? How much epinephrine is enough? Garcia et al. published a retrospective study in AJEM discussing cumulative epinephrine dosage in cardiac arrest. Although the study includes a variety of patient settings, such as CT surgery and cath lab patients, which may not be directly applicable to ED patients, it’s […]

Resuscitation recently published an article that assessed the association between intramuscular (IM) epinephrine and survival outcomes, including survival to hospital discharge, survival to hospital admission, and functional survival. Although there is ongoing debate regarding the role of epinephrine in cardiac arrest, this study demonstrated that IM epinephrine improved survival. Link to article

The accuracy of EKG diagnosis following cardiac arrest and return of spontaneous circulation (ROSC), particularly when determining the need to activate the Cath lab during the middle of the night, can be highly challenging. Baldi et al. published this study regarding “Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography […]

NEJM study in 2016 showed no survival benefits or favorable neurological outcome regarding use of Amiodarone vs Lidocaine vs placebo in OHCA. In a recent publication by Acad Emerg Med, a post hoc analysis of original study was done and the authors found time to Amiodarone in OHCA could be associated with better survival to […]

There are bunch of rumors that come to play regarding what other medications we can use in cardiac arrest patient, Calcium, Sodium Bicarb, tPA,… A study published in JAMA tried to answer part of this question: “Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest, […]

Very interesting study in patients who got ROSC and had an ECG. Patients with an ECG before 7 minutes after ROSC had more false positive ECG findings in favor of STEMI vs 8-33 minutes and more than 33 minutes. Link to study

It has been a very difficult time for Epi since last 5 years! 2011: Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial 2012: Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest 2014: Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients? and now […]

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest, which one is your choice? The 2015 update of ACLS is still recommending Amio in Vfib, VTach Cardiac arrest after Shock and Epi, But new study in NEJM proved that among 3026 patients who randomized to Amiodarone (974), Lidocaine (993), or Placebo (1059), there were no statistically […]

In a meta-analysis published in Resuscitation, 10 observational study reviewed and showed among patients with out of hospital cardiac arrest, patients who intubated via ETT had significantly better

OXYGEN! Please put  patient on NC 2 -4. This is one of our critical action in mock oral board questions, but is it really a critical action, how much oxygen do we need for a pt w/o hypoxemia?

Medical Principles and Practice published an article that uses a structured teaching tools to summarized 5 Hs and 5 Ts in PEA cardiac arrest, Lets start with 5 Hs(Hyper and Hypo K, Hypoxia, Hydrogen, Hypovolemia and Hypothermia) and 5 Ts( Tension PTX, Tamponade, Trauma, Toxins, Thrombosis), a very routine practice in ACLS guideline,

Wow. This is the third one, after 2 articles that showed Epi in prehospital really does not decrease mortality , now this retrospective study presenteddata that none of patients with asystole and no

In October 2011, I reviewed an interesting article in Resuscitation, September 2011 regarding use of Epinephrine in per-hospital setting, ,now we have another study published in JAMA, March 2012.

This is a very interesting study regarding usage of epinephrine in out of hospital setting.  This is probably the first control trial in human post cardiac arrest. The study is about