Epinephrine in Anaphylaxis: Higher Risk of Cardiovascular Complications and Overdose After Administration of Intravenous Bolus Epinephrine Compared with Intramuscular Epinephrine
Epinephrine in Anaphylaxis: Higher Risk of Cardiovascular Complications and Overdose After Administration of Intravenous Bolus Epinephrine Compared with Intramuscular Epinephrine
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DOI：
10.1016/j.jaip.2014.06.007
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发表时间：
2015-01-01
影响因子：
9.4
通讯作者：
Hess, Erik P.
中科院分区：
文献类型：
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作者：
Campbell, Ronna L.;Bellolio, Fernanda;Hess, Erik P.
背景：肾上腺素是治疗过敏反应的首选药物，而致命的过敏反应与肾上腺素的延迟给药有关。关于心血管不良并发症和肾上腺素过量的数据有限。目的：比较急诊科过敏反应患者不同给药途径的心血管不良事件和肾上腺素过量的发生率。方法：这是一项2008年4月至2012年7月的观察性队列研究。符合过敏反应诊断标准的急诊科患者包括在内。我们收集了人口学数据、肾上腺素给药途径、触发因素、过量用药和不良心血管事件，包括心律失常、心肌缺血、中风、心绞痛和高血压。结果：研究队列包括573名患者，其中301名(57.6%)接受了至少一剂肾上腺素。301例患者共注射肾上腺素362剂：67.7%肌注，19.6%肌注，8.3%皮下注射，3.3%静脉推注，1.1%静脉持续滴注。8例患者共发生8次CV不良反应和4次过量用药。所有过量用药均发生在静脉推注肾上腺素时。不良心血管事件与静脉注射肾上腺素30剂中的3剂相关，而注射肾上腺素316剂中的4剂相关(10%比1.3%；优势比8.7[95%可信区间1.8-40.7]，P=0.006)。同样，静脉注射肾上腺素30次中有4次出现过量，而注射肾上腺素316次中只有0次(13.3%vs0%；优势比61.3[95%CI，7.5 to infinity]，P<；.001)。结论：静脉注射肾上腺素过量和不良心血管事件的风险显著增加。对数据的分析支持肌注肾上腺素的安全性，并需要极端谨慎和关于静脉推注肾上腺素在过敏反应中的进一步教育。(C)2014年美国过敏、哮喘和免疫学学会
BACKGROUND: Epinephrine is the drug of choice for the management of anaphylaxis, and fatal anaphylaxis is associated with delayed epinephrine administration. Data on adverse cardiovascular (CV) complications and epinephrine overdose are limited.OBJECTIVE: To compare rates of CV adverse events and epinephrine overdoses associated with anaphylaxis management between various routes of epinephrine administration among patients with anaphylaxis in the emergency department.METHODS: This was an observational cohort study from April 2008 to July 2012. Patients in the emergency department who met diagnostic criteria for anaphylaxis were included. We collected demographics; route of epinephrine administration; trigger; overdose; and adverse CV events, including arrhythmia, cardiac ischemia, stroke, angina, and hypertension.RESULTS: The study cohort included 573 patients, of whom, 301 (57.6%) received at least 1 dose of epinephrine. A total of 362 doses of epinephrine were administered to 301 patients: 67.7% intramuscular (IM) autoinjector, 19.6% IM injection, 8.3% subcutaneous injection, 3.3% intravenous (IV) bolus, and 1.1% IV continuous infusion. There were 8 CV adverse events and 4 overdoses with 8 different patients. All the overdoses occurred when epinephrine was administered IV bolus. Adverse CV events were associated with 3 of 30 doses of IV bolus epinephrine compared with 4 of 316 doses of IM epinephrine (10% vs 1.3%; odds ratio 8.7 [95% CI, 1.8-40.7], P = .006). Similarly, overdose occurred with 4 of 30 doses of IV bolus epinephrine compared with 0 of 316 doses of IM epinephrine (13.3% vs 0%; odds ratio 61.3 [95% CI, 7.5 to infinity], P < .001).CONCLUSION: The risk of overdose and adverse CV events is significantly higher with IV bolus epinephrine administration. Analysis of the data supports the safety of IM epinephrine and a need for extreme caution and further education about IV bolus epinephrine in anaphylaxis. (C) 2014 American Academy of Allergy, Asthma & Immunology