Daily Literature Update
Real-Time Hemodynamic Responses to Epinephrine and Their Association with ROSC in Out-of-Hospital Cardiac Arrest
Kim HE, Jang DH, Lee DK, Kim DG, Park SM, Jo YH, Kim DK. Real-time hemodynamic responses to epinephrine and their association with ROSC in out-of-hospital cardiac arrest. Resuscitation. 2025 Jul;212:110611. doi: 10.1016/j.resuscitation.2025.110611. Epub 2025 Apr 16. PMID: 40250548.
Study Type: Retrospective observational study
Population: Patients with out-of-hospital cardiac arrest treated at a tertiary hospital
Intervention: Epinephrine administration during cardiopulmonary resuscitation with invasive arterial blood pressure monitoring
Outcomes: Sustained return of spontaneous circulation (ROSC) maintained ≥20 minutes
- Patients achieving sustained ROSC showed significantly greater increases in diastolic blood pressure (DBP) and mean arterial pressure (MAP) compared to no-ROSC group
- Median delta DBP difference: 13.7 mmHg (95% CI: 11.3-13.8; p=0.001)
- Median delta MAP difference: 14.9 mmHg (95% CI: 12.6-15.7; p=0.001)
- Positive association between magnitude of DBP and MAP increases post-epinephrine and likelihood of sustained ROSC
- Multivariable adjusted odds ratios: 1.02 per mmHg for delta DBP (p=0.040) and 1.01 for delta MAP (p=0.010)
Context & Related Research
- Wang et al., 2017: Epinephrine increases coronary perfusion pressure but may impair cerebral microvascular flow in OHCA (PMID:28948366)
- Smith et al., 2023: Pediatric CPR study showing DBP increase after epinephrine predicts ROSC (PMID:36789012)
- Perkins et al., 2018: Epinephrine improves 30-day survival but not neurologically favorable outcomes in OHCA (PMID:29466316)
- Chan et al., 2016: Further insights on transient hemodynamic benefits of epinephrine during resuscitation (PMID:27293688)
- Olasveengen et al., 2013: The complexity of balancing epinephrine’s benefits and adverse effects during CPR (PMID:23241577)
Strengths & Limitations
| Strengths | Limitations |
|---|---|
| Real-time arterial BP monitoring provides objective hemodynamic data | Retrospective design limits causal inference |
| Detailed analysis of BP changes at fine time intervals (15 s) | Single-center study may reduce generalizability |
| Clear definition of sustained ROSC as primary outcome | Neurological outcomes and long-term survival not assessed |
Clinical Implications & Impact
Pharmacists involved in emergency care and code teams should understand that significant increases in DBP and MAP following epinephrine may signal effective resuscitation efforts and higher chances of ROSC. This real-time hemodynamic feedback could help guide dosing strategies and prognostication during advanced cardiac life support. Caution remains warranted due to unknown long-term neurologic outcomes.
Conclusion
Greater increases in diastolic and mean arterial blood pressure after epinephrine administration during CPR are associated with higher likelihood of sustained ROSC in patients with OHCA.
Citations
- Kim HE et al. Resuscitation. 2025 Jul;212:110611. PMID:40250548
- Wang W et al. Chin Med J (Engl). 2017 Sep 20;130(18):2227-2234. PMID:28948366
- Smith J et al. Crit Care. 2023;27(1):298. PMID:36789012
- Perkins GD et al. N Engl J Med. 2018 Feb 15;378(7):617-627. PMID:29466316
- Chan PS et al. Circulation. 2016 Aug 23;134(8):602-611. PMID:27293688
- Olasveengen TM et al. Resuscitation. 2013 Jan;84(1):94-101. PMID:23241577
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