{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:42:58Z","timestamp":1761198178838,"version":"3.37.3"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Advanced Cardiovascular Life Support (ACLS) guidelines recommend intravenous (IV) and intraosseous (IO) epinephrine as a basic cornerstone in the resuscitation process. Data about the efficacy and safety of intracoronary (IC) epinephrine during cardiac arrest in the catheterization laboratory are lacking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To examine the efficacy and safety of IC vs. IV epinephrine for resuscitation during cardiac arrest in the catheterization laboratory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This is a prospective observational study that included all patients who experienced cardiac arrest in the cath lab at two tertiary centres in Egypt from January 2015 to July 2022. Patients were divided into two groups according to the route of epinephrine given; IC vs. IV. The primary outcome was survival to hospital discharge. Secondary outcomes included rate of return of spontaneous circulation (ROSC), time-to-ROSC, and favourable neurological outcome at discharge defined as modified Rankin Scale (MRS) &amp;lt;3. A total of 162 patients met our inclusion criteria, mean age (60.69\u00a0\u00b1\u00a09.61), 34.6% women. Of them, 52 patients received IC epinephrine, and 110 patients received IV epinephrine as part of the resuscitation. Survival to hospital discharge was significantly higher in the IC epinephrine group (84.62%\u00a0vs. 53.64%, P\u00a0&amp;lt;\u00a00.001) compared with the IV epinephrine group. The rate of ROSC was higher in the IC epinephrine group (94.23%\u00a0vs. 70%, P\u00a0&amp;lt;\u00a00.001) and achieved in a shorter time (2.6\u00a0\u00b1\u00a01.97 min vs. 6.8\u00a0\u00b1\u00a02.11 min, P\u00a0&amp;lt;\u00a00.0001) compared with the IV group. Similarly, favourable neurological outcomes were more common in the IC epinephrine group (76.92%\u00a0vs. 47.27%, P\u00a0&amp;lt;\u00a00.001) compared with the IV epinephrine group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In this observational study, IC epinephrine during cardiac arrest in the cath lab appeared to be safe and may be associated with improved outcomes compared with the IV route. Larger randomized studies are encouraged to confirm these results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcad013","type":"journal-article","created":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T05:59:58Z","timestamp":1676095198000},"page":"99-103","source":"Crossref","is-referenced-by-count":6,"title":["Outcomes with intracoronary vs. intravenous epinephrine in cardiac arrest"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9180-4260","authenticated-orcid":false,"given":"Mahmoud","family":"Tantawy","sequence":"first","affiliation":[{"name":"College of Medicine, Department of Cardiology, Misr University for Science and Technology , Cairo , Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghada","family":"Selim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Ain Shams University , Cairo , Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwan","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University"},{"name":"Lifespan Cardiovascular Institute , Providence, RI , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwan","family":"Tamara","sequence":"additional","affiliation":[{"name":"Facult\u00e9 de medicine, Universit\u00e9 de Montr\u00e9al , Montreal , Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameh","family":"Mosaad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, MTI University , Cairo , Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"2024011212420326600_bib1","article-title":"In-hospital cardiac arrest and post-arrest care","volume-title":"Strategies to Improve Cardiac Arrest Survival: A Time to Act","author":"Committee on the Treatment of Cardiac Arrest: Current Status and Future Directions; Board on Health Sciences Policy; Institute of Medicine","year":"2015"},{"key":"2024011212420326600_bib2","doi-asserted-by":"crossref","first-page":"1686350","DOI":"10.1155\/2019\/1686350","article-title":"In-hospital cardiac arrest in the cardiac catheterization laboratory: effective transition from an ICU- to CCU-led resuscitation team","volume":"2019","author":"Sharma","year":"2019","journal-title":"J Interv Cardiol"},{"key":"2024011212420326600_bib3","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/ccd.29113","article-title":"Efficacy and safety of intracoronary epinephrine versus conventional treatments alone in STEMI patients with refractory coronary no-reflow during primary PCI: the RESTORE observational study","volume":"97","author":"Navarese","year":"2021","journal-title":"Catheter Cardiovasc Interv"},{"key":"2024011212420326600_bib4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12872-015-0004-6","article-title":"Intracoronary epinephrine in the treatment of refractory no-reflow after primary percutaneous coronary intervention: a retrospective study","volume":"15","author":"Aksu","year":"2015","journal-title":"BMC Cardiovasc Disord"},{"key":"2024011212420326600_bib5","doi-asserted-by":"crossref","first-page":"2951","DOI":"10.21608\/ejhm.2021.191657","article-title":"Efficacy of distal intracoronary epinephrine and glycoprotein iib\/iiia inhibitors in the treatment of No-reflow during percutaneous","volume":"85","author":"Tantawy","year":"2021","journal-title":"Egypt J Hosp Med"},{"key":"2024011212420326600_bib6","first-page":"95","article-title":"Pharmacological management of no reflow during percutaneous coronary intervention","volume":"4","author":"Porto","year":"2006","journal-title":"CurrVascPharmacol"},{"key":"2024011212420326600_bib7","doi-asserted-by":"crossref","first-page":"739","DOI":"10.4070\/kcj.2013.43.11.739","article-title":"Usefulness of intracoronary epinephrine in severe hypotension during percutaneous coronary interventions","volume":"43","author":"Choi","year":"2013","journal-title":"Korean Circ J"},{"key":"2024011212420326600_bib8","first-page":"95","article-title":"Massive coronary artery air embolism due to an unusual cause","volume":"10","author":"Tziatzios","year":"2018","journal-title":"Interv Med Appl Sci"},{"key":"2024011212420326600_bib9","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.resuscitation.2021.02.011","article-title":"European Resuscitation Council Guidelines 2021","volume":"161","author":"Lott","year":"2021","journal-title":"Resuscitation"},{"key":"2024011212420326600_bib10","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1177\/003693305700200504","article-title":"Cerebral vascular accidents in patients over the age of 60. 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