Interesting NAEMSP Abstracts

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Safety and Efficacy of Intramuscular Epinephrine in Acute Asthma

Exacerbations Doug A. Isaacs, P. Freese, Ben-Eli, J.

Prezant, New York City Fire Department, Brooklyn, New York

Objective: To describe the cardiovascular response to epinephrine given

intramuscularly (IM) for patients with acute asthma exacerbations not

responding to other interventions as well as the clinical response to

epinephrine. Methods: A retrospective review of electronic prehospital call

reports during a 1-year period, August 2005 to July 2006, was performed.

Inclusion criteria included a documented history of asthma, a chief

complaint of dyspnea or asthma or respiratory failure, and the

administration of intramuscular epinephrine. Exclusion criteria included

cardiopulmonary arrest or respiratory arrest. Results: Two hundred

forty-three patients met inclusion criteria. Eight cases were excluded:

three cardiac arrest prior to any intervention, four anaphylaxis cases, and

one documentation error. The average age was 25.7 years (range = 0.75-79).

The mean systolic blood pressure (SBP) change was -0.13 mmHg, with a

statistically significant change (> 18 mmHg, p < 0.05) among only five

patients (2.1%). No significant change was noted in mean arterial pressure

following epinephrine administration. Eleven patients (4.7%) had significant

heart-rate change (ge 20 bpm, p-value < 0.05). None of the available EKGs

demonstrated signs of ischemic changes. Following epinephrine

administration, paramedics documented improved clinical status for 183

patients (77.9 %), no change in 21 patients (8.9%), and clinical

deterioration in only 1 patient (0.4%) who had a documented use of cocaine

prior to their exacerbation. The severity of patients asthma was gauged by

the use of outpatient steroids in 33.2% (78/183) (both inhaled and oral) and

past intubations in 19.1% (35/183). No reassessment of clinical status was

noted for 30 patients (12.8%) Additional medication use among those with

documented improvement included multiple albuterol treatments (176/183), and

intravenous steroids (90/183), intravenous magnesium sulfate (63/183).

Assisted ventilation was required for 27 patients given epinephrine at time

it was initiated or shortly thereafter, 8 had shown clinical improvement.

Among ALS medications administered, epinephrine alone had significant

correlation with improvement (LR = 6.78). Conclusions: Following

intramuscular epinephrine administration, most patients experience no

significant cardiovascular compromise. Clinical improvement is frequently

noted, including those patients for whom ventilatory assistance is required.

These findings suggest that epinephrine administration is both safe and

efficacious in this population.