Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study.
Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study.
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DOI：
10.1136/bmj.f6829
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发表时间：
2013-12-10
期刊：
影响因子：
--
通讯作者：
Sakamoto T
中科院分区：
文献类型：
--
作者：
Nakahara S;Tomio J;Takahashi H;Ichikawa M;Nishida M;Morimura N;Sakamoto T
目的评价院前急诊对院外心脏骤停患者应用肾上腺素的效果。设计对照倾向匹配的回顾性队列研究，在该研究中，使用基于时间依赖倾向评分的顺序风险集匹配创建肾上腺素或非肾上腺素（对照）患者对。设置2007年1月至2010年12月期间登记的院外心脏骤停患者的日本全国登记数据库。在15-94岁的旁观者目击的院外心脏骤停患者中，我们创建了1990对有或没有肾上腺素的初始心律为心室颤动或无脉性室性心动过速（VF/VT）的患者和9058对无VF/VT的患者。主要观察指标：1个月或出院时（以较早者为准）的总体和神经系统完整生存率。结果倾向匹配后，急诊医疗服务院前给肾上腺素与VF/VT患者的总生存率较高相关（17.0% vs 13.4%；未经调整的优势比1.34,95%可信区间1.12 ~ 1.60），但与神经完整生存率无关（6.6% vs 6.6%; 1.01, 0.78 ~ 1.30）；非vf /VT患者的总生存率（4.0% vs 2.4%；比值比1.72,1.45 ~ 2.04）和神经完整生存率（0.7% vs 0.4%; 1.57, 1.04 ~ 2.37）较高。结论院前急诊医疗机构给予肾上腺素可改善院外心脏骤停患者的长期预后，尽管神经系统完整生存率的绝对增加很小。
Objectives To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest. Design Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score. Setting Japan’s nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010. Participants Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT. Main outcome measures Overall and neurologically intact survival at one month or at discharge, whichever was earlier. Results After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT. Conclusions Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.
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