The following is the summary of “A prospective observational study on impact of epinephrine administration route on acute myocardial infarction patients with cardiac arrest in the catheterization laboratory (iCPR study),” published in the December 2022 issue of Critical care by Aldujeli, et al.

Although epinephrine is frequently used in cardiac arrest, it is unknown whether or not the delivery route influences outcomes for patients experiencing cardiac arrest due to acute myocardial infarction. The purpose of this study was to evaluate the relative efficacy of peripheral intravenous (IV), central IV, and intracoronary (IC) administration of epinephrine.

Prospective pilot cohort study of patients with acute myocardial infarction who experienced cardiac arrest during the percutaneous coronary intervention at 2 academic medical centers. Patients who got epinephrine through peripheral IV, central IV, or IC were compared for their results.

There were a total of 158 people registered; 48 (30.4%), 50 (31.6%), and 60 (38.0%) were assigned to the central IV, IC, and peripheral IV arms, respectively. When compared to central IV and IC administration, the peripheral IV route of epinephrine was linked with a lower likelihood of achieving the return of spontaneous circulation (ROSC, odds ratio=0.14, 95% confidence range=0.05-0.36, P<0.0001). (The results were the same whether the IV or IC was administered centrally or peripherally; P=0.9343.) Comparing the IC route to the peripheral IV route or the central IV route, the IC route significantly increased the risk of stent thrombosis (IC vs. peripheral IV OR=4.6, 95% CI=1.5-14.3, P=0.0094; IC vs. central IV OR=6.0, 95% CI=1.9-19.2, P=0.0025). 

After ROSC, the central IV and IC routes produced superior neurological outcomes compared to the peripheral IV route. When compared to peripheral IV administration, central IV and IC administration of epinephrine was linked to a higher ROSC rate and improved neurologic outcomes. There was an increased danger of stent thrombosis when ICs were used.