Dr. Peter Antevy explains why giving epinephrine fast during cardiac arrest matters. A 2019 study cut time-to-epinephrine from 16 minutes to 5 minutes and improved survival. But the PARAMEDIC-2 trial found no benefit when delays stretched to 21 minutes, showing timing is everything.
Questions this video answers
They reduced epinephrine timing from 16 minutes to 7 minutes to 5 minutes.
About 8,000 adults total; ~4,000 received epinephrine and ~4,000 received normal saline.
Approximately 21.5 minutes from 911 call to epinephrine and about 16.5 minutes from arrival on scene to epinephrine.
Draw 1 mL of 1:1,000 (1 mg/mL) epinephrine and add to 9 mL normal saline to create 1:10,000.
Chapters
Hey everyone, this is Dr. Peter Entevi for another edition of the HENT Heavy Minute. Today I want to talk about epinephrine and the timing of epinephrine. We've had some posts in the past on hence heavy minute on epinephrine, but now there's so much more information and I think it's very important that you do it right. So what do we know from the 2019 resuscitation paper published by Dr. Paul Banerjee and Dr. Paul Pepe? We now know that early EPI is important. They actually brought their EPI down from 16 minutes to 7 minutes to 5 minutes. And every time they brought that EPI timing down, the numbers went up. The CPC 1 and 2 for those children, neurologically normal children, went up. So why do a lot of people want to get rid of EPI altogether? Well, it's probably because of studies like the paramedic two trials, that study from England where they had 8,000 adults, 4,000 got EPI, 4,000 got normal saline. And it turns out that the neuro intact survival was no different between the two groups. But it turns out that it took 21 and a half minutes from the time the 911 call came in, or 16 and a half minutes from the time of arrival on scene and therefore there was no change in survival. So if it takes you 16 and a half minutes to get EPI on board for cardiac arrest after you've shown up on scene, nobody will live in that particular case. Of course, we need expertly perform BLS. First the IO's got to go in rapidly and then the EPI's got to go in rather quickly. You really have to time yourselves in training. And then during your cqi, look at how you're performing in the field. Where was that EPI dose being given? How long did it take after you got to the side of the patient where that EPI went in? The last thing I want to talk about is, is the EPI shortage. So many of us have experienced a 1 in 10,000 shortage. So what do you have to do? You have to understand and learn how to take that 1 to 1000, take 1 milliliter of that, add it to 9 milliliters of normal saline and now you've made cardiac arrest. EPI 1 in 10,000. You got to know how to do this. It's important to know where EPI works, the physiology of why it works, and then how to give it easily and quickly on scene. That'll get more kids back to life, It'll get more adults back to life, mainly the ones in non chockable rhythms. This has been Dr. Peter Antevi for another edition of the.
