Handtevy Minute - Is Epi a Trick or a Treat?

Hi everyone, this is Dr. Peter Entebbe with another edition of the Gentavi Minute. Happy Halloween. And here we are at Gentavi. We're saving lives every day. I wanted to talk about a couple of very important trials that come out recently that deal with epinephrine, cardiac arrest and outcomes. The first one is Paramedic two. And Paramedic two trial looked at epinephrine versus placebo. So I wanted to show you the data here. This data came from the New England Journal, was published in August of 2018. And essentially what they did, they looked at 8,000 cardiac arrest victims. Half of them got epinephrine, 1 in 10,000. And the other half of them got placebo. It was in a syringe that looked like epinephrine. And those patients who arrived at the hospital with a pulse, you could see in the epinephrine group was much higher, 24 versus 8%. But when you looked at overall the neuro intact survival, did they walk out of the hospital normal? The two groups had no difference, 2.2% versus 1.9%. And so I think the very important piece now to understand when you look at the data is that the average time to epinephrine in that study was 21 and a half minutes. That's a very long time from the moment that the patient went down. Now these are all in adults. So now I want to take you to this study which is looking at early versus late epinephrine. Does the timing matter? So let's take a look at this study. This came out in March of 2018. In circulation they had 32,000 patients approximately. And really what it shows, especially for pediatrics that for every one minute delay there was a 9% decrease in the odds of survival. This is similar to what we see in an aed. So putting those two things together, let's not go to high performance epr. How can you give epinephrine early and make it effective? And the way to do that is by practicing a pre arrival regimen, meaning that you know the dose of epinephrine before you get there. So here's a video from one of my agencies and this is how we actually get to that number prior to getting there, knowing the age.

Hey listen, it's a seven year old. Looks like a drowning. If it's an actual cardiac arrest.

You'Re.

Going to be airway, you'll be cpr, I'll be monitor and drilling.

All right.

Since your airway, your kinks will be either a 2.5 or a 3 depending on what size it, but it can go either or. Alright, defibrillation. The first one's at 50, the rest are 100. The epi's are 2.5 ML. And if they are in fib or they're in V tach, we'll do amiodro and it's 2.5ml as well. Alright, I'm gonna drill them right when we get there.

Okay. So that's how it's done. So Polk County, Florida has been doing this for a couple of years. This is what their outcomes are with early epinephrine after hyp, quality BLS on scene. And you can see this graphic showing that in 2012 and 13 they had no pediatric survivors. Now in 15 and 16 and even more so in 17 and 18, they have a 35% or more neurologic intact survival. That's impressive and that's really what we're trying to get to. So if you want to see all that in action this year at the Expo at the EMS World Clinical Challenge, the HENTAVI system is going to be used by the teams in that challenge. We also invite you to come. The Genti pediatric course is going to be on. We're talking patient safety. I'll be doing a two hour class with my captains and my lieutenants from Palm beach on high performance epr. That'll be on Thursday. We're talking mih, we're talking stroke and so we're really excited to be coming to Nashville. We hope you join us there. And again, if you want to see any more of these Hent Heavy minutes, just pop onto the website hent heavy.com this has been Dr. Peter Entebbe for another edition of the Hent Heavy Minute. Happy Halloween.