Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis.
Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis.
复制标题
DOI：
10.1136/bmj-2021-066534
复制
发表时间：
2021-11-10
期刊：
影响因子：
--
通讯作者：
American Heart Association’s Get With The Guidelines-Resuscitation investigators
中科院分区：
文献类型：
--
作者：
Evans E;Swanson MB;Mohr N;Boulos N;Vaughan-Sarrazin M;Chan PS;Girotra S;American Heart Association’s Get With The Guidelines-Resuscitation investigators
确定除颤前使用肾上腺素治疗院内室性心律失常引起的心脏骤停，并检查其与患者生存率的相关性。倾向匹配分析。2000-18年数据来自497家参与美国心脏协会指南复苏登记的医院。年龄在18岁及以上的成人，由于初始可电击心律而在医院内发生心脏骤停，并接受除颤治疗。首次除颤前给予肾上腺素。存活至出院;良好的神经系统存活率，定义为使用脑功能分类评分测量的无、轻度或中度神经功能障碍的出院存活率;以及急性复苏后的存活率（即，恢复自主循环>20分钟）。进行了时间依赖性倾向匹配分析，以调整适应症造成的混杂因素，并评价除颤前肾上腺素与研究结局的独立相关性。在34820例初始可电击心律的患者中，7054例（20.3%）在除颤前接受了肾上腺素治疗，与现行指南相反。与先接受除颤治疗的参与者相比，先接受肾上腺素治疗的参与者不太可能有心肌梗死或心力衰竭病史，但更可能有肾衰竭，败血症，呼吸功能不全，并在住院心脏骤停前接受机械通气（标准化差异>10%）。除颤前肾上腺素治疗与延迟除颤密切相关（中位数4分钟vs 0分钟）。倾向匹配分析（6569对配对），除颤前肾上腺素与出院存活率较低相关（22.4% v29.7%;校正比值比0.69; 95%置信区间0.64 - 0.74; P<0.001），有利的神经系统生存率（15.8% vs21.6%; 0.68; 0.61 ~ 0.76; P<0.001）和急性复苏后存活率（61.7% vs69.5%; 0.73; 0.67 ~ 0.79; P<0.001）。上述结果在一系列敏感性分析中是一致的，包括根据除颤时间进行匹配。与目前的指南相反，由于可电击心律导致的院内心脏骤停优先考虑立即除颤，五分之一的患者在除颤前接受肾上腺素治疗。除颤前使用肾上腺素与较差的生存结局相关。
To determine the use of epinephrine (adrenaline) before defibrillation for treatment of in-hospital cardiac arrest due to a ventricular arrhythmia and examine its association with patient survival. Propensity matched analysis. 2000-18 data from 497 hospitals participating in the American Heart Association’s Get With The Guidelines-Resuscitation registry. Adults aged 18 and older with an index in-hospital cardiac arrest due to an initial shockable rhythm treated with defibrillation. Administration of epinephrine before first defibrillation. Survival to discharge; favorable neurological survival, defined as survival to discharge with none, mild, or moderate neurological disability measured using cerebral performance category scores; and survival after acute resuscitation (that is, return of spontaneous circulation for >20 minutes). A time dependent, propensity matched analysis was performed to adjust for confounding due to indication and evaluate the independent association of epinephrine before defibrillation with study outcomes. Among 34 820 patients with an initial shockable rhythm, 7054 (20.3%) were treated with epinephrine before defibrillation, contrary to current guidelines. In comparison with participants treated with defibrillation first, participants receiving epinephrine first were less likely to have a history of myocardial infarction or heart failure, but more likely to have renal failure, sepsis, respiratory insufficiency, and receive mechanical ventilation before in-hospital cardiac arrest (standardized differences >10% for all). Treatment with epinephrine before defibrillation was strongly associated with delayed defibrillation (median 4 minutes v 0 minutes). In propensity matched analysis (6569 matched pairs), epinephrine before defibrillation was associated with lower odds of survival to discharge (22.4% v 29.7%; adjusted odds ratio 0.69; 95% confidence interval 0.64 to 0.74; P<0.001), favorable neurological survival (15.8% v 21.6%; 0.68; 0.61 to 0.76; P<0.001) and survival after acute resuscitation (61.7% v 69.5%; 0.73; 0.67 to 0.79; P<0.001). The above findings were consistent in a range of sensitivity analyses, including matching according to defibrillation time. Contrary to current guidelines that prioritize immediate defibrillation for in-hospital cardiac arrest due to a shockable rhythm, one in five patients are treated with epinephrine before defibrillation. Use of epinephrine before defibrillation was associated with worse survival outcomes.
登录
查看更多内容
影响因子：
120.7
作者：
Nadkarni, VM;Larkin, GL;Berg, RA
通讯作者：
Berg, RA
影响因子：
158.5
作者：
Chan, Paul S.;Krumholz, Harlan M.;Nallamothu, Brahmajee K.
通讯作者：
Nallamothu, Brahmajee K.
影响因子：
120.7
作者：
Andersen, Lars W.;Raymond, Tia T.;Donnino, Michael W.
通讯作者：
Donnino, Michael W.
DOI：
10.1161/circoutcomes.119.005580
发表时间：
2019-07-01
影响因子：
6.9
作者：
Holmberg, Mathias J.;Ross, Catherine E.;Sawyer, Taylor
通讯作者：
Sawyer, Taylor
影响因子：
1.8
作者：
Morales-Cané I;Valverde-León MD;Rodríguez-Borrego MA
通讯作者：
Rodríguez-Borrego MA