Epinephrine may save the heart, but not the brain, says study
March 20th, 2012
04:59 PM ET

Epinephrine may save the heart, but not the brain, says study

Using the drug epinephrine during a cardiac arrest may do more harm than good, says a new study.

Researchers at the Kyushu University School of Medicine in Japan looked at the medical records of more than 400,000 cardiac arrest patients over a three-year period and found that while the drug may be effective in the short-term, it may not improve survival outcomes in the long-term.

According to the report, patients who received doses of the adrenaline-like drug in the ambulance were three times more likely to regain a heartbeat before they reached the hospital, when compared to those who did not get the drug.

But patients who got the drug were about half as likely to be alive one month after the incident; and only a quarter of those that survived were able to function normally.

Although epinephine is the standard of care for treating out-of-hospital cardiac arrests, some doctors are not surprised at the study's findings.

"Community studies have shown that things like bystander CPR and public-access defibrillators have been successful, and that [advanced life support] interventions are not," said Dr. Alex Isakov, director of Emory University's Section of Pre-Hospital and Disaster Medcine. "This study just confirms what we've believed to be true for some time."

Study authors say in the paper that one possible reason for the negative outcomes associated with epinephrine may be due to the very nature of the drug – it causes veins around the body to clamp down and shunt blood towards the heart to keep it fueled.

Although that's the intended effect of the drug, that clamping down of vessels may starve other parts of the body that need blood for long-term survival. In short, epinephrine may save the heart, but not the brain or the rest of the body, they say.

Although the drug has been used regularly since the 1960s, very few good studies have been done comparing epinephrine to a placebo, because withholding a drug known to improve short-term survival would be considered unethical.

Isakov says the latest report could change that.

"This large study - which suggests not only that there's no improvement in cardiac arrest survival with epinephrine, but that perhaps those who did not receive the drug had better outcomes - might open the door to a placebo controlled trial," said Isakov.

He also says this study should be cause to focus on things we know help improve survival rates.

"Bystander CPR and timely defibrillation are known to improve outcomes," he said. "For communities that want to improve out of hospital cardiac arrest survival, that's what they should focus on."

soundoff (18 Responses)
  1. Research Board

    This study sounds very bias. Chances are, if you got epinephrine as a drug during cardiac arrest, you were sicker, or had arrested longer than someone who didn't. Meaning, if someone had a cardiac arrest for 3 minutes and didn't get epinephrine, and had pulses back at 5 minutes, compared to someone who had an arrest for 6 minutes, got epinephrine and got pulses back at 10 minutes, you can say that epinephrine gives pulses back 4 minutes after injection compared to a 5 minute arrest in non-epinephrine group or was associated with a return of pulses 20% faster, despite the fact that the person was without a heartbeat for twice as long (5 minutes versus 10 minutes) and is going to have a worse outcome. This is called selection bias.

    March 22, 2012 at 17:37 | Report abuse | Reply
  2. duck

    -Research board
    Without reading the actual study that's impossible to say, they may have controlled for down time and other similar factors factors.

    March 22, 2012 at 21:38 | Report abuse | Reply
  3. Mary

    What about people who use Epipens went they have allergic reactions. These are young children. Are their brains at risk the way a heart attack patients are?

    March 23, 2012 at 08:09 | Report abuse | Reply
    • crpeterson

      I was thinking the same thing as you, Mary. I have an Epi-pen for my anaphylactic allergies and know that it can and has saved my life a few times! I am thinking this article was talking about patients who receive epinephrine during a cardiac episode that has nothing to do with allergic reactions. I'd still be curious to hear what they have to say about epinephrine for allergic reactions.

      March 26, 2012 at 08:38 | Report abuse |
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