Impact of Intracoronary Versus Intravenous Epinephrine Administration During Cardiac Arrest . ((iCPR))

Lithuanian University of Health Sciences

Status

Completed

Conditions

Cardiopulmonary Arrest

Epinephrine Causing Adverse Effects in Therapeutic Use

Treatments

Drug: Epinephrin

Study type

Observational

Funder types

Other

Identifiers

NCT05253937

LUHSKC-175

Details and patient eligibility

About

In hospital cardiac arrest (IHCA) is a major challenge imposed on almost all health care systems worldwide. Despite significant progress in cardiopulmonary resuscitation in the past few years, outcomes remain relatively poor with an approximate 49 % survival rate.

Epinephrine administration remains a cornerstone in the treatment of cardiac arrest. However, the preferred route of administration remains a matter of debate within the medical community .

Various routes of administration, including intravenous, intramuscular, intraosseous and endotracheal routes have been studied.

Initially, American guidelines for the treatment of cardiac arrest recommended injection of 0.5 mg of epinephrine directly into the right ventricle through the parasternal approach, aiming to achieve higher peak intracardiac concentrations and a more central effect, however the intravenous route remained preferable due to its feasibility and safety .

To our knowledge, intra-coronary epinephrine administration for intraprocedural cardiac arrest has not been evaluated or compared with other routes of administration.

Enrollment

160 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Aged above 18 years old
Diagnosed with non-ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI)
Received dual antiplatelet therapy (acetylsalicylic acid and ticagrelor), or triple therapy (oral anticoagulant, acetylsalicylic acid and clopidogrel)
Event of cardiac arrest during percutaneous intervention

Exclusion criteria

cardiac arrest documented prior to being transported to cardiac catheterization laboratory.
Patients who suffered cardiac arrest for less than 60 seconds were excluded from the study.
Received mechanical circulatory support such as intra-aortic balloon pump, temporary percutaneous ventricular assist devices, or extracorporeal membrane oxygenation (ECMO) during hospitalization.
Presenting with any cardiac rhythm on admission other than sinus rhythm or atrial fibrillation/flutter
Signs of infection or a history of hepatic, oncologic or allergy to contrast media and end stage renal failure
Patients who underwent primary fibrinolysis.
Furthermore, patients who received atropine, amiodarone, lidocaine, or any other antiarrhythmic prior to CPR
who received targeted temperature management post CPR .