EPI in Cardiac Arrest - study

[Just Plain Ruff]

A new study, limited by the Japanese EMS structure but it's a good study. Discuss!!

http://prehospitalmed.com/2015/06/29/effects-of-prehospital-epinephrine-administration-on-neurological-outcomes-in-patients-with-out-of-hospital-cardiac-arrest/

[paramedicmike]

I heard some interesting discussion about this study (in combination with several other Japanese and Korean studies) not too long ago. It seems that many times when codes are worked in Japan and places in Korea, where densely populated apartment buildings and small elevators are the norm, patients, prior to transport, are secured to the stretcher in a foot down head up position much like standing. The thought is that this position facilitates drainage from the brain much like in a live person. The question raised is whether or not this positioning affects outcome.

[rock_shoes]

Intuitively the reported results make sense. In my own experience with enough epi and bicarb you can get ROSC out of a rock. That doesn't mean the person will have survival to discharge.

At this point it appears that epi is more beneficial than harmful in cardiac arrest. I would expect the next logical step regarding epi will be dosage determination. Is 1mg IV q 3-5 minutes the ideal dose? Should it be more? Less? An infusion instead of bolus dosing?