Epinephrine and Outcome after Cardiac Arrest

Paul E. Gause

doi:10.7326/0003-4819-130-11-199906010-00007

Letters |1 June 1999

Epinephrine and Outcome after Cardiac Arrest

Paul E. Gause, MD

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TO THE EDITOR:

I have several concerns about Behringer and colleagues' article on epinephrine and outcome after cardiac arrest (1).

The authors focused on patients who did not respond to initial attempts at defibrillation. With each passing aliquot of time, nonresponders receive continuing cardiopulmonary resuscitation (CPR) and the prescribed epinephrine regimen. Further difficulties establishing “down time” before institution of bystander CPR and the unsubstantiated overall effectiveness of this CPR affect stratification according to “no-flow” or “low-flow” duration. The result is a subselection of a group that has a poor prognosis and receives more epinephrine if the protocols are followed.

Although patients with evidence of previous heart disease or neurologic impairment were excluded from the outset, the authors do not indicate whether pupillary reactivity was assessed. This sign is often ignored by first responders and is overlooked during continuation of resuscitation. Some patients who are “free” of underlying heart disease or central nervous system impairment may have already experienced their fatal insult.

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Letters |1 June 1999

Epinephrine and Outcome after Cardiac Arrest

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Letters |1 June 1999

Epinephrine and Outcome after Cardiac Arrest

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