Background Clinical trials have not shown a benefit of high doses of epinephrine in the management of cardiac arrest.
We conducted a prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest.
Methods Adult patients who had cardiac arrest outside the hospital were enrolled if the cardiac rhythm continued to be ventricular fibrillation despite the administration of external electrical shocks, or if they had asystole or pulseless electrical activity at the time epinephrine was administered.
We randomly assigned 3327 patients to receive up to 15 high doses (5 mg each) or standard doses (1 mg each) of epinephrine according to the current protocol for advanced cardiac life support.
Results In the high-dose group, 40.4 percent of 1677 patients had a return of spontaneous circulation, as compared with 36.4 percent of 1650 patients in the standard-dose group (P=0.02) ; 26.5 percent of the patients in the high-dose group and 23.6 percent of those in the standard-dose group survived to be admitted to the hospital (P=0.05) ; 2.3 percent of the patients in the high-dose group and 2.8 percent in the standard-dose group survived to be discharged from the hospital (P=0.34).
There was no significant difference in neurologic status according to treatment among those discharged. (...)
Mots-clés Pascal : Arrêt cardiocirculatoire, Pronostic, Long terme, Fibrillation ventriculaire, Asystolie, Dose forte, Etude double insu, Etude comparative, Randomisation, Epinéphrine(médicament), Agoniste, Récepteur alpha-adrénergique, Neuromédiateur, Catécholamine, Dose standard nominale, Adulte, Homme, Appareil circulatoire pathologie, Cardiopathie, Trouble rythme cardiaque, Trouble excitabilité, Traitement
Mots-clés Pascal anglais : Cardiocirculatory arrest, Prognosis, Long term, Ventricular fibrillation, Asystole, High dose, Double blind study, Comparative study, Randomization, Epinephrine(drug), Agonist, alpha-Adrenergic receptor, Neuromediator, Catecholamine, Standard nominal dose, Adult, Human, Cardiovascular disease, Heart disease, Arrhythmia, Excitability disorder, Treatment
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0071892
Code Inist : 002B12A02. Création : 31/05/1999.