The city chief medical officer recently modified emergency paramedic epinephrine usage in response to a potential national shortage of the medication.
Medical director Dr. Jeffrey Jarvis and Fort Worth’s medical control advisory board approved a shift in emergency medicine protocol last week.
City first responders will no longer administer additional epinephrine infusions for nonshockable cardiac arrest victims who’ve already received an epinephrine injection. Patients with nonshockable rhythms, or heart rates that can’t reset with an automatic defibrillator, will still receive the initial dose of epinephrine.
If a cardiac arrest victim who has a return of spontaneous circulation goes through another rearrest, additional epinephrine will not be administered — instead, norepinephrine, a medication meant to increase blood pressure, will be given.
The change will not affect patients negatively, Jarvis said.
“The reason we’re making a change is we have to conserve epinephrine because of the shortage, but we’re doing it in a way that I don’t expect to have a change in outcomes overall,” he said to the Fort Worth Report.
Epinephrine commonly treats allergic anaphylactic shock and helps patients suffering from cardiac arrest see a return of circulation.
Epinephrine shortages are not a new phenomenon. Generic drugs and medications used commonly by medical staff, including epinephrine and IV fluids, continuously see shortages, Jarvis said.
The U.S. Food and Drug Administration indicated the expected shortage will likely be short term.
Nevertheless, this permanent shift in use protocols is meant to guarantee that any future shortages don’t affect Fort Worth Fire Department’s emergency medical services,” Jarvis said.
“We have a real and unavoidable operational need to conserve the prefilled syringes of epinephrine for patients that clearly benefit from it — that’s pediatric patients who need a push dose of epi and things that we obviously need it for, like anaphylaxis,” Jarvis said at the medical control advisory board on April 23.
At the meeting, Jarvis indicated recent scientific findings found epinephrine overuse may be harmful in the long run. He noted cardiac arrest survivors who received additional epinephrine more often experience “neurological devastation,” or permanent damage to the nervous system.
“Epinephrine saves the heart at the expense of the brain, so we can get the heart beating again, but we’re not getting the brain back,” Jarvis said. “And the brain is obviously the important part here.”
Recent scientific findings also found reduced use of epinephrine may help older patients in certain situations, Jarvis added.
Ismael M. Belkoura is the health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at ismael.belkoura@fortworthreport.org.
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