TUESDAY, March 20 (HealthDay News) -- The decades-old practice
of treating cardiac arrest patients with epinephrine -- adrenaline
-- might do more harm than good in the long run, suggests a new
analysis of hundreds of thousands of cases.
Japanese researchers found that cardiac arrest patients given
epinephrine were more likely to survive one month, compared with
those who didn't get the treatment. But when the investigators
adjusted their figures statistically so they wouldn't be thrown off
by various factors, the patients who got epinephrine actually
became less likely to survive a month.
And among those given epinephrine who did survive, only
one-quarter of them were in good shape neurologically a month
later, the study authors noted.
On the other hand, the patients who received the drug were more
likely to have their pulses restored before they got to the
hospital, according to the report published in the March 21 issue
Journal of the American Medical Association.
Dr. Clifton Callaway, an executive vice chair of emergency
medicine at the University of Pittsburgh who wrote an accompanying
journal editorial, said the new findings raise questions about the
routine use of the drug.
"We need to figure out why those patients aren't doing well," Callaway said. "It improves that likelihood that we'll get the heartbeat back, but it looks like we're paying a price."
Cardiac arrest occurs when the heart fails to beat properly.
It's not the same as a heart attack, although a heart attack can
lead to cardiac arrest.
Physicians and paramedics often use epinephrine in conjunction
with cardioversion -- the shocking of the heart with electricity --
to restore the heart to its normal rhythm in patients with cardiac
Although the drug was once given directly to the heart through a
long needle, that doesn't happen anymore, Callaway said. The new
study examined its use as an intravenous treatment.
The study looked at nearly 420,000 cases of cardiac arrest that
occurred in Japan between 2005 and 2008 in adults. The patients
were all treated by emergency personnel and taken to hospitals.
It was fairly uncommon for patients to receive epinephrine
during the time period. For some of that time, emergency medical
personnel who weren't doctors couldn't legally administer it in
When epinephrine was given to patients, the unadjusted results
showed that 5.4 percent were still alive a month later, compared
with 4.7 percent of those who didn't get the treatment. This isn't
unusual, as cardiac arrest patients rarely survive.
Of those who did survive and had received epinephrine, only 25
percent did well neurologically. That's substantially lower than in
patients who didn't receive epinephrine in other studies, the
"This finding implies that epinephrine administration might save the heart but not the brain," study lead author Dr. Akihito Hagihara, a professor in the department of health services, management and policy at Kyushu University Graduate School of Medicine in Fukuoka City, and colleagues wrote.
Previous research has linked epinephrine to irregular
heartbeats, disruptions in the functioning of the heart and
disrupted circulation in the brain, Hagihara pointed out. "Negative
effects might be due to these," he said.
Hagihara suggested that it's not time to abandon epinephrine
entirely because the study findings still need to be verified.
While the study found an association between epinephrine for
cardiac arrest and poor survival and neurological outcomes, it did
not prove a cause-and-effect relationship.
For more about
cardiac arrest, visit the U.S. National Library of Medicine.
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