Adrenaline

BMJ. 2013 Dec 10;347:f6829.

Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study.[Pubmed: 24326886]

To evaluate the effectiveness of pre-hospital Adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest. DESIGN: Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) Adrenaline were created with a sequential risk set matching based on time dependent propensity score. SETTING: Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010.
METHODS AND RESULTS:
Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without Adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT. Overall and neurologically intact survival at one month or at discharge, whichever was earlier. RESULTS: After propensity matching, pre-hospital administration of Adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT.
CONCLUSIONS:
Pre-hospital administration of Adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.

Resuscitation. 2014 Mar;85(3):350-8.

Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data.[Pubmed: 24252225]

BACKGROUND AND AIM: Expert guidelines for treatment of cardiac arrest recommend administration of Adrenaline (epinephrine) every three to five minutes. However, the effects of different dosing periods of Adrenaline remain unclear. We sought to evaluate the association between Adrenaline average dosing period and survival to hospital discharge in adults with an in-hospital cardiac arrest (IHCA). METHODS: We performed a retrospective review of prospectively collected data on 20,909 IHCA events from 505 hospitals participating in the Get With The Guidelines-Resuscitation (GWTG-R) quality improvement registry. Adrenaline average dosing period was defined as the time between the first Adrenaline dose and the resuscitation endpoint, divided by the total number of Adrenaline doses received subsequent to the first Adrenaline dose. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. RESULTS: Compared to a referent Adrenaline average dosing period of 4 to <5 min per dose, survival to hospital discharge was significantly higher in patients with the following Adrenaline average dosing periods: for 6 to <7 min/dose, adjusted odds ratio [OR], 1.41 (95%CI: 1.12, 1.78); for 7 to <8 min/dose, adjusted OR, 1.30 (95%CI: 1.02, 1.65); for 8 to <9 min/dose, adjusted OR, 1.79 (95%CI: 1.38, 2.32); for 9 to <10 min/dose, adjusted OR, 2.17 (95%CI: 1.62, 2.92). This pattern was consistent for both shockable and non-shockable cardiac arrest rhythms. CONCLUSION: Less frequent average Adrenaline dosing than recommended by consensus guidelines was associated with improved survival of in-hospital cardiac arrest.

J Pharm Pharmacol. 2015 Jan;67(1):20-5.

Adrenaline (epinephrine) microcrystal sublingual tablet formulation: enhanced absorption in a preclinical model.[Pubmed: 25256073]

For anaphylaxis treatment in community settings, Adrenaline (epinephrine) administration using an auto-injector in the thigh is universally recommended. Despite this, many people at risk of anaphylaxis in community settings do not carry their prescribed auto-injectors consistently and hesitate to use them when anaphylaxis occurs.The objective of this research was to study the effect of a substantial reduction in Adrenaline (Epi) particle size to a few micrometres (Epi microcrystals (Epi-MC)) on enhancing Adrenaline dissolution and increasing the rate and extent of sublingual absorption from a previously developed rapidly disintegrating sublingual tablet (RDST) formulation in a validated preclinical model.
METHODS AND RESULTS:
The in-vivo absorption of Epi-MC 20 mg RDSTs and Epi 40 mg RDSTs was evaluated in rabbits. Epi 0.3 mg intramuscular (IM) injection in the thigh and placebo RDSTs were used as positive and negative controls, respectively. Epimean (standard deviation) area under the plasma concentration vs time curves up to 60 min and Cmax from Epi-MC 20 mg and Epi 40 mg RDSTs did not differ significantly (P > 0.05) from Epi 0.3 mg IM injection. After Adrenaline, regardless of route of administration, pharmacokinetic parameters were significantly higher (P < 0.05) than after placebo RDSTs administration (reflecting endogenous Adrenaline levels).
CONCLUSIONS:
Epi-MC RDSTs facilitated a twofold increase in Epi absorption and a 50% reduction in the sublingual dose. This novel sublingual tablet formulation is potentially useful for the first-aid treatment of anaphylaxis in community settings.