Efficacy of bolus-dose epinephrine to manage hypotension in the prehospital setting
Efficacy of bolus-dose epinephrine to manage hypotension in the prehospital setting
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DOI：
10.1016/j.ajem.2021.07.006
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发表时间：
2021-07-21
影响因子：
3.6
通讯作者：
French, David M.
中科院分区：
文献类型：
--
作者：
Weant, Kyle A.;French, David M.
目的：急诊室（艾德）和院前环境中的低血压与显著的发病率和死亡率相关。有限的文献存在探索利用静脉（IV）推注剂量肾上腺素（BDE）的紧急医疗服务（EMS）。方法：回顾性审查评估了患者运送到学术医疗中心谁收到了IV BDE由一个单一的城市EMS系统从2016年至2020年。主要结局是评估IV BDE对收缩压（SBP）的影响。次要目的是评估心率（HR）的变化、剂量变异性对SBP的影响以及严重高血压（SBP > 220 mmHg）的发生率。最常见的单次剂量为10 μ g（76.0%），45.5%接受多次剂量。基于体重的溴化二苯醚中位剂量为0.14微克/千克。与基线相比，所有患者在BDE给药后的SBP显著增加（中位数14.0 mmHg）（p 10 μ g），SBP的增加显著大于接受10 μ g的患者（30.0 mmHg vs. 11.0 mmHg; p = 0.022）。同样，接受剂量>= 0.2 μ g/kg的患者与接受剂量>= 0.2 μ g/kg的患者相比，
Purpose: Hypotension in the Emergency Department (ED) and the prehospital setting has been associated with significant morbidity and mortality. Limited literature exists exploring the utilization of intravenous (IV) bolus-dose epinephrine (BDE) by Emergency Medical Services (EMS).Methods: A retrospective review evaluated patients transported to an academic medical center who had received IV BDE by a single urban EMS system from 2016 to 2020. The primary outcome was to assess the influence IV BDE had on systolic blood pressure (SBP). Secondary objectives were to assess changes in heart rate (HR), the impact of dose variability on SBP, and the incidence of severe hypertension (SBP > 220 mmHg).Results: A total of 55 patients who received 96 administrations of IV BDE were included in the analysis. The most common individual dose was 10 mu g (76.0%) and 45.5% received multiple doses. The median weight-based dose of BDE was 0.14 mu g/kg. A significant increase in SBP (median 14.0 mmHg) was noted among all patients following BDE administration compared with baseline (p 10 mu g were noted to have a significantly greater rise in SBP than those that received 10 mu g (30.0 mmHg vs. 11.0 mmHg; p = 0.022). Similarly, patients that received a dose >= 0.2 mu g/kg had a significantly greater increase in SBP compared with those that received