Impact of Early Intravenous Epinephrine Administration on Outcomes Following Out-of-Hospital Cardiac Arrest
Impact of Early Intravenous Epinephrine Administration on Outcomes Following Out-of-Hospital Cardiac Arrest
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DOI：
10.1253/circj.cj-11-1433
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发表时间：
2012-07-01
影响因子：
3.3
通讯作者：
Kai, Tatsuro
中科院分区：
文献类型：
--
作者：
Hayashi, Yasuyuki;Iwami, Taku;Kai, Tatsuro
工作背景：肾上腺素管理心脏骤停的有效性已被证明在动物模型，但临床效果仍然是有争议的。方法和结果：一个前瞻性的，以人口为基础的，观察性研究在大坂涉及连续的院外心脏骤停（OHCA）患者从2007年1月至2009年12月。我们评估了成人非创伤性旁观者见证的OHCA患者的结局，当地协议指示紧急医疗服务人员给予肾上腺素。按首次记录的心律分层后，比较以下组的结局：未给药，从急诊呼叫到肾上腺素给药的时间≥ 21 min。共有3,161例患者符合我们的分析条件，其中1,013例（32.0%）实际接受了肾上腺素治疗。肾上腺素组的1个月神经系统完整生存率显著低于非肾上腺素组（4.1% vs. 6.1%，P=0.028）。在室颤（VF）骤停的情况下，与非肾上腺素组相比，早期肾上腺素组中在10分钟内接受肾上腺素给药的患者的1个月神经系统完整生存率显著更高（66.7% vs. 24.9%），尽管其他肾上腺素组没有。在非室颤逮捕的情况下，神经系统完整的1个月生存率低，无论肾上腺素administration.Conclusions：肾上腺素的有效性后OHCA取决于给药的时间。在早期给予肾上腺素时，OHCA伴VF的神经功能结局有所改善。(Circ J 2012; 76：1639-1645）
Background: The effectiveness of epinephrine administration for cardiac arrests has been shown in animal models, but the clinical effect is still controversial.Methods and Results: A prospective, population-based, observational study in Osaka involved consecutive out-of-hospital cardiac arrest (OHCA) patients from January 2007 through December 2009. We evaluated the outcomes among adult non-traumatic bystander-witnessed OHCA patients for whom the local protocol directed the emergency medical service personnel to administer epinephrine. After stratifying by first documented cardiac rhythm, outcomes were compared among the following groups: non-administration, = 21 min as the time from emergency call to epinephrine administration. A total of 3,161 patients were eligible for our analyses, among whom 1,013 (32.0%) actually received epinephrine. The epinephrine group had a significantly lower rate of neurologically intact 1-month survival than the non-epinephrine group (4.1% vs. 6.1%, P=0.028). In cases of ventricular fibrillation (VF) arrest, patients in the early epinephrine group who received epinephrine administration within 10 min had a significantly higher rate of neurologically intact 1-month survival compared with the non-epinephrine group (66.7% vs. 24.9%), though other epinephrine groups did not. In cases of non-VF arrest, the rate of neurologically intact 1-month survival was low, irrespective of epinephrine administration.Conclusions: The effectiveness of epinephrine after OHCA depends on the time of administration. When epinephrine is administered in the early phase, there is an improvement in neurological outcome from OHCA with VF. (Circ J 2012; 76: 1639-1645)