PMID- 34864289
OWN - NLM
STAT- MEDLINE
DCOM- 20220126
LR  - 20220719
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 52
DP  - 2022 Feb
TI  - Comparison of push-dose phenylephrine and epinephrine in the emergency 
      department.
PG  - 43-49
LID - S0735-6757(21)00937-2 [pii]
LID - 10.1016/j.ajem.2021.11.033 [doi]
AB  - BACKGROUND: There is limited evidence to support the efficacy and safety of 
      push-dose vasopressor (PDP) use outside of the operating room (OR). Specifically, 
      there are few head-to-head comparisons of different PDP in these settings. The 
      purpose of this study was to compare the efficacy and safety of push-dose 
      phenylephrine (PDP-PE) and epinephrine (PDP-E) in the Emergency Department (ED). 
      METHODS: This retrospective, single-center study evaluated adults given PDP-PE or 
      PDP-E in the ED from May 2017 to November 2020. The primary outcome was a change 
      in heart rate (HR). Secondary outcomes included changes in blood pressure, 
      adverse effects, dosing errors, fluid and vasopressor requirements, ICU and 
      hospital lengths of stay (LOS), and in-hospital mortality. RESULTS: Ninety-six 
      patients were included in the PDP-PE group and 39 patients in the PDP-E group. 
      Median changes in HR were 0 [-7, 6] and - 2 [-15, 5] beats per minute (BPM) for 
      PDP-PE and PDP-E, respectively (p = 0.138). PDP-E patients had a greater median 
      increase in systolic blood pressure (SBP) (33 [24, 53] vs. 26 [8, 51] mmHg; 
      p = 0.049). Dosing errors occurred more frequently in patients that received 
      PDP-E (5/39 [12.8%] vs. 2/96 [2.1%]; p = 0.021). PDP-E patients more frequently 
      received continuous epinephrine infusions before and after receiving PDP-E. There 
      were no differences in adverse effects, fluid requirements, LOS, or mortality. 
      CONCLUSION: PDP-E provided a greater increase in SBP compared to PDP-PE. However, 
      dosing errors occurred more frequently in those receiving PDP-E. Larger 
      head-to-head studies are necessary to further evaluate the efficacy and safety of 
      PDP-E and PDP-PE.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Nam, Elizabeth
AU  - Nam E
AD  - Clinical Pharmacist, Loma Linda University Medical Center, 11234 Anderson St, 
      Loma Linda, CA 92354, USA. Electronic address: elnam@llu.edu.
FAU - Fitter, Scott
AU  - Fitter S
AD  - Clinical Pharmacy Specialist - Emergency Medicine, Loma Linda University Medical 
      Center, Loma Linda University School of Pharmacy, 24745 Stewart St. Shryock Hall, 
      Loma Linda, CA 92350, USA.
FAU - Moussavi, Kayvan
AU  - Moussavi K
AD  - Faculty, Clinical Education, Providence St. Joseph of Orange, Department of 
      Pharmacy Practice, College of Pharmacy, Marshall B. Ketchum University, 2575 
      Yorba Linda Blvd. Fullerton, CA 92831, USA. Electronic address: 
      kmoussavi@ketchum.edu.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20211125
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Vasoconstrictor Agents)
RN  - 1WS297W6MV (Phenylephrine)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
CIN - Am J Emerg Med. 2022 Aug;58:311-312. PMID: 35287975
CIN - Am J Emerg Med. 2022 Aug;58:325-326. PMID: 35331617
MH  - Aged
MH  - Blood Pressure/drug effects
MH  - Emergency Service, Hospital/organization & administration/statistics & numerical 
      data
MH  - Epinephrine/*administration & dosage/adverse effects
MH  - Female
MH  - Heart Rate/drug effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Phenylephrine/*administration & dosage/adverse effects
MH  - Retrospective Studies
MH  - Vasoconstrictor Agents/*administration & dosage/adverse effects
OTO - NOTNLM
OT  - Pharmacology
OT  - Shock
OT  - Vasopressor
COIS- Declaration of Competing Interest We have no relevant conflicts of interest to 
      disclose.
EDAT- 2021/12/06 06:00
MHDA- 2022/01/27 06:00
CRDT- 2021/12/05 21:10
PHST- 2021/08/12 00:00 [received]
PHST- 2021/10/27 00:00 [revised]
PHST- 2021/11/21 00:00 [accepted]
PHST- 2021/12/06 06:00 [pubmed]
PHST- 2022/01/27 06:00 [medline]
PHST- 2021/12/05 21:10 [entrez]
AID - S0735-6757(21)00937-2 [pii]
AID - 10.1016/j.ajem.2021.11.033 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2022 Feb;52:43-49. doi: 10.1016/j.ajem.2021.11.033. Epub 2021 Nov 
      25.