-
Use of a drug-related problem oriented medical record in the medication review of critically ill patients Randomized clinical trial1 Topic1 Quiz
-
PACULit Daily Literature Update: Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease a propensity matched analysis1 Topic1 Quiz
-
PACULit Daily Literature Update: Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury a retrospective study1 Topic1 Quiz
-
PACULit Daily Literature Update: AsNeeded AlbuterolBudesonide in Mild Asthma1 Topic1 Quiz
-
PACULit Daily Literature Update: Thiamine as a metabolic resuscitator after in hospital cardiac arrest1 Topic1 Quiz
-
PACULit Daily Literature Update: The Effect of Early Fluid Resuscitation on Mortality in Sepsis A Systematic Review and Meta Analysis1 Topic1 Quiz
-
PACULit Daily Literature Update: Inhaled isoflurane for sedation of mechanically ventilated children in intensive care (IsoCOMFORT): a multicentre, randomised, active-control, assessor-masked, non-inferiority phase 3 trial1 Topic1 Quiz
-
PACULit Daily Literature Update: Prevalence risk factors and consequences of early clinical deterioration under noninvasive ventilation in emergency department patients a prospective multicentre observational study of the French IRU Network1 Topic1 Quiz
-
PACULit Daily Literature Update: Evaluation of Stress Dose Hydrocortisone Tapers in Septic Shock1 Topic1 Quiz
-
Opportunistic Screening for Atrial Fibrillation With Continuous ECG Monitoring in the Emergency Department1 Topic1 Quiz
-
PACULit Daily Literature Update: Efficacy of targeting high mean arterial pressure for older patients with septic shock OPTPRESS a multicentre pragmatic open label randomised controlled trial1 Quiz
-
PACULit Daily Literature Update: Evaluation of Etomidate Use and Association with Mortality Compared with Ketamine among Critically Ill Patients1 Topic1 Quiz
-
PACULit Daily Literature Update: Andexanet alfa increases 30-day thrombotic events relative to four-factor prothrombin complex concentrate for factor Xa inhibitors related intracerebral hemorrhage in veterans1 Topic1 Quiz
-
PACULit Daily Literature Update: Antibiotic De-Escalation Practices in the Intensive Care Unit A Multicenter Observational Study1 Topic1 Quiz
-
PACULit Daily Literature Update: Fludrocortisone to treat patients with aneurysmal subarachnoid haemorrhage Protocol for an international phase 3 randomised placebocontrolled multicentre trial1 Topic1 Quiz
-
PACULit Daily Literature Update: Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest1 Topic1 Quiz
-
PACULit Daily Literature Update: Real-Time Hemodynamic Responses to Epinephrine and Their Association with ROSC in Out-of-Hospital Cardiac Arrest1 Topic1 Quiz
-
Reevaluating bicarbonate therapy in pediatric DKA A propensity scorematched analysis of neurological and respiratory outcomes1 Topic1 Quiz
-
PACULit Daily Literature Update: Establishing discordance rate of estimated glomerular filtration rate between serum creatinine based calculations and cystatin C based calculations in critically ill patients1 Topic1 Quiz
-
Alteplase for Posterior Circulation Ischemic Stroke at 45 to 24 Hours1 Topic1 Quiz
-
2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines1 Topic2 Quizzes
-
ACPE Required Forms: PACULit Literature Updates September 2025: Emergency Medicine & Critical Care3 Topics
Participants 440
Lesson 17,
Topic 1
In Progress
PACULit Daily Literature Update: Real-Time Hemodynamic Responses to Epinephrine and Their Association with ROSC in Out-of-Hospital Cardiac Arrest
Lesson Progress
0% Complete
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
Listen to the Podcast
A short discussion of today’s highlight.