.jpg "Sarah Singer, PharmD photo")
Sarah Singer, PharmD
PGY2 Critical Care Pharmacy Resident
Barnes Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Hannah Pope, BCPS, PharmD
Clinical Pharmacy Specialist
Barnes Jewish Hospital, United States
Disclosure information not submitted.
Brian Fuller, MD, MSCI,FCCM
Associate Professor of Anesthesiology and Emergency Medicine
Washington University/Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Gabrielle Gibson, PharmD, BCCCP, BCPS
Clinical Pharmacy Specialist
Barnes Jewish Hosptial, United States
Disclosure information not submitted.
Title: The Safety and Efficacy of Push Dose Epinephrine in Critically Ill Adults
INTRODUCTION/HYPOTHESIS: Push dose pressors (PDP) have commonly been utilized in the operating room (OR) for management of acute and/or transient hypotension. Recently, the role of PDPs has expanded to other off-label indications including hypotension due to procedures, bridge to a continuous vasopressor, and other transient hypotensive events. While this has become a more common practice in hospitals nationwide, there are a lack of data supporting the use outside of the OR. The purpose of this study was to assess the safety, efficacy, and characteristics of responders to push dose epinephrine in the critically ill population outside of the OR.
Methods: Patients included in the study were >18 years old and received at least one dose of push dose epinephrine (10 mcg/mL) between June 2018 and July 2020. The primary efficacy outcome was the incidence of ≥25% increase in systolic blood pressure (SBP) within 60 minutes post administration. Patients where then identified as responders or non-responders based on this outcome. Multiple safety parameters were assessed including incidence of tachycardia, hypertension requiring IV anti-hypertensives, and need for continuous vasopressors.
Results: After exclusion, 142 episodes, correlating to 123 patients, were included in the study. Of those, 102 (71.8%) episodes were classified as responders and 40 (28.2%) episodes were classified as nonresponders. Epinephrine responders had a significant increase in SBP when compared to nonresponders (60 mmHg vs. 3 mmHg; p< 0.001), respectively. Incidence of tachycardia was not significantly different between responders and nonresponders (45.1% vs. 32.5%; p=0.171). Responders were more likely to be Caucasian (55.9% vs. 37.5%; p=0.049), have higher APACHE II scores (21 vs 18; p=0.007), and more likely to be on a continuous infusion vasopressor during PDP administration (32.4% vs 15%; p=0.037). There was no difference in cardiac arrest within 60 minutes of push dose epinephrine administration, in-hospital mortality, ICU or hospital length of stay.
Conclusions: Push dose epinephrine is safe and efficacious in patients for the treatment of acute hypotensive episodes.