Prehospital hypotension: bolus-dose epinephrine yields less survival

  • Guyette FX & al.
  • Prehosp Emerg Care
  • 15.03.2019

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Although for profound prehospital hypotension, bolus-dose epinephrine (BDE) increases BP, potentially allowing time for resuscitative measures, mortality risk remains increased.
  • Residual confounding is possible in this observational study, and controlled trials are needed.

Why this matters

  • Some have advocated for BDE in this setting and some emergency services have adopted it, but results keep showing increased mortality risk.

Key results

  • 35% of patients received BDE.
  • Survival at 25 hours was 65% with BDE and 82% with controls (P<.001>
  • Survival was also lower in the BDE group at discharge (43% vs 60%; P<.001 and at days vs p>
  • BDE treatment was associated with increased systolic BP.
  • Cases in the BDE group were not significantly more severe.

Study design

  • Retrospective case-cohort study of 3302 critical care transport patients with severe hypotension (systolic BP,
  • Funding: None disclosed.

Limitations

  • Residual confounding, selection and survival bias possible.