Anaphylaxis: epinephrine corrected cardiovascular collapse

Clinical bottom line (level 1c)

  1. 90% of patients with severe anaphylaxis during anaesthesia had a systolic blood pressure > 40 mmHg.
  2. Arrhythmias, particularly supraventricular tachycardias were common.
  3. Epinephrine resuscitated almost all patients.
Fisher : Anaesthesia and Intensive Care 1986; 14: 17-21
Expires November 2004

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospital, Australia

227 patients (aged ?, ?% male) with severe reactions suspected to be anaphylaxis during anaesthesia



Outcomes studied:
  • cardiovascular collapse systolic blood pressure > 40 mmHg
  • cardiac arrhythmia
  • supraventricular tachycardia
  • response to epinephrine

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    cardiovascular collapse ? 205/227 90%
    (86% to 94%)
    cardiac arrhythmia ? 186/227 82%
    (77% to 87%)
    supraventricular tachycardia ? 153/227 67%
    (61% to 74%)
    response to epinephrine ? 137/142 96%
    (93% to 100%)

    Comments

    1. Other sympathomimetic agents used were less effective than epinephrine.

    Citation

    1. Fisher MM, : clinical observations on the pathophysiology and treatment of anaphylactic cardiovascular collapse. Anaesthesia and Intensive Care 1986; 14: 17-21
    Search Terms: ?
    Contributor: Mike Bennett and Chris Ball, November 1999
    Reviewer: Richard Koopmans

    Clinical Question.
    Patient severe anaphylaxis during anaesthesia
    Intervention or Exposure epinephrine
    Outcome resuscitation