{
  "abstract": "Background Despite advances in cardiopulmonary resuscitation (CPR), outcomes remain suboptimal. Epinephrine is essential during in-hospital cardiac arrest, but the optimal administration route remains controversial.Purpose This study compared return of spontaneous circulation (ROSC) rates following peripheral intravenous (IV), central IV, or arterial intracoronary (IC) epinephrine administration in acute myocardial infarction (AMI) patients experiencing cardiac arrest during catheterization procedures.Methods We conducted a prospective two-center pilot cohort study at high-volume percutaneous coronary intervention (PCI) centers. The study included AMI patients who suffered cardiac arrest during PCI procedures. Resuscitation followed European Resuscitation Council Guidelines. Central IV access was prioritized when available; otherwise, physicians chose between peripheral IV or arterial IC routes at their discretion. The primary outcome was ROSC achievement. Statistical analysis included Chi-Square and Kruskal-Wallis tests with appropriate post-hoc comparisons and logistic regression modelling.Results The study enrolled 158 patients: 48 (30.4%) received central IV, 50 (31.6%) arterial IC, and 60 (38.0%) peripheral IV epinephrine. Median age was 71 years [IQR: 61–80], with 56% male participants. Patient characteristics were generally comparable across groups, with differences in age (peripheral IV patients older than IC), haemoglobin levels (lowest in peripheral route), and pre-CPR heart rhythms (more electromechanical dissociation in peripheral route). Overall, 111 patients (70%) achieved ROSC. Peripheral IV administration was associated with significantly lower odds of ROSC compared to central IV (odds ratio 0.14, 95% CI: 0.05–0.36, p<0.0001), while central IV and IC routes showed similar outcomes (p=0.9343). Epinephrine route alone demonstrated good predictive value for ROSC (AUC=0.73).Conclusion Epinephrine administration route significantly influenced ROSC rates in AMI patients undergoing CPR in catheterization laboratories. Both arterial IC and central IV administration demonstrated superior outcomes compared to peripheral IV administration.",
  "authors": [
    {
      "affiliations": [
        "University of Galway, Galway, Ireland",
        "Lithuanian University of Health Sciences, Kaunas, Lithuania",
        "Bon Secours Hospital Limerick, Limerick, Ireland"
      ],
      "name": "A Aldujeli"
    },
    {
      "affiliations": [
        "St James’s Hospital, Dublin, Ireland"
      ],
      "name": "F Azani"
    },
    {
      "affiliations": [
        "Baylor Scott and White Research Institute, Dallas, TX, USA"
      ],
      "name": "KM Tecson"
    },
    {
      "affiliations": [
        "Connolly Hospital Blanchardstown, Dublin, Ireland"
      ],
      "name": "S Rana"
    },
    {
      "affiliations": [
        "Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation, Minneapolis, MN, USA"
      ],
      "name": "A Haq"
    },
    {
      "affiliations": [
        "University of Limerick, Limerick, Ireland"
      ],
      "name": "T Kiernan"
    },
    {
      "affiliations": [
        "Lithuanian University of Health Sciences, Kaunas, Lithuania"
      ],
      "name": "V Tatarunas"
    },
    {
      "affiliations": [
        "Lithuanian University of Health Sciences, Kaunas, Lithuania"
      ],
      "name": "R Braukyliene"
    },
    {
      "affiliations": [
        "Lithuanian University of Health Sciences, Kaunas, Lithuania"
      ],
      "name": "K Briedis"
    },
    {
      "affiliations": [
        "Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation, Minneapolis, MN, USA"
      ],
      "name": "ES Brilakis"
    }
  ],
  "title": "22 Epinephrine delivery route and resuscitation outcomes in catheterization laboratory cardiac arrests: a prospective multi-center observational study (iCPR)",
  "uid": "73fbaab8-bde7-57af-bf05-46d202760c75"
}