Low chance of survival among patients requiring adrenaline (epinephrine) or intubation after out-of-hospital cardiac arrest in Sweden
Low chance of survival among patients requiring adrenaline (epinephrine) or intubation after out-of-hospital cardiac arrest in Sweden
复制标题
DOI：
10.1016/s0300-9572(02)00048-5
复制
发表时间：
2002-07-01
期刊：
影响因子：
6.5
通讯作者：
Herlitz, J
中科院分区：
文献类型：
--
作者：
Holmberg, M;Holmberg, S;Herlitz, J
目的：将院外心脏骤停的结局与是否给予肾上腺素（肾上腺素）药物以及患者是否插管相关。患者：1990-1995年在瑞典进行的一项全国性调查，调查对象是院外心脏骤停并尝试复苏的患者。瑞典有60%的救护车组织参加了这项活动。设计：前瞻性评价。生存率定义为心脏骤停后1个月的生存率。结果：共有14065例患者纳入评价。其中，10966例患者尝试了复苏。其中42.4例给予肾上腺素（肾上腺素），47.5%插管。在一项单变量分析中，当所有患者均接受评估时，肾上腺素（肾上腺素）和插管治疗与较低的生存率相关。在包括年龄、性别、心脏骤停地点、旁观者-CPR、初始心律失常、目击心脏骤停和病因的多变量分析中，肾上腺素（epinephrine）治疗（OR 0.43，CI 0.27-0.66）和插管（OR 0.71，CI 0.51-0.99）均为生存率较低的独立预测因素。当单独分析旁观者目击心脏骤停的患者时，发现室颤和需要3次以上的电击，肾上腺素治疗或插管与生存率无关。在非电击节律患者中，肾上腺素（肾上腺素）治疗是较低生存率的重要独立预测因素（OR 0.30，CI 0.07-0.82）。结论：在瑞典的一项全国性调查中，包括10966例院外心脏骤停病例，结果与是否给予肾上腺素（肾上腺素）药物治疗和患者是否插管有关。无论是在总体上还是在任何亚组中，我们都没有发现表明这两种干预措施中任何一种有益效果的结果。用肾上腺素或插管治疗是否会增加院外心脏骤停后的生存率需要在前瞻性随机试验中证实。(C)2002年由Elsevier Science爱尔兰有限公司出版。
Aim: To relate the outcome of out-of-hospital cardiac arrest to whether medication with adrenaline (epinephrine) was given and whether patients were intubated. Patients: A national survey in Sweden between 1990-1995 among patients suffering out-of-hospital cardiac arrest and in whom resuscitation was attempted. Sixty per cent of ambulance organisations in Sweden participated. Design: Prospective evaluation. Survival was defined as survival I month after cardiac arrest. Results: In all, 14065 patients were included in the evaluation. Of these, resuscitation was attempted in 10 966 cases. Among these adrenaline (epinephrine) was given in 42.4 and 47.5% were intubated. In an univariate analysis treatment with adrenaline (epinephrine) and intubation was associated with a lower survival when all patients were evaluated. In a multivariate analysis including age, sex, place of arrest, bystander-CPR, initial arrhythmia, arrest being witnessed and aetiology, treatment with adrenaline (epinephrine) (OR 0.43, CI 0.27-0.66) and intubation (OR 0.71, CI 0.51-0.99) were both independent predictors of a lower chance of survival. When separately analysing patients with bystander witnessed cardiac arrest found in ventricular fibrillation and requiring more than 3 defibrillatory shocks neither treatment with adrenaline (epinephrine) nor intubation was associated with survival. Among patients with a non-shockable rhythm treatment with adrenaline (epinephrine) was a significant independent predictor for lower survival (OR 0.30, CI 0.07-0.82). Conclusion: In a national survey in Sweden including 10966 cases of out-of-hospital cardiac arrest the outcome was related to whether medication with adrenaline (epinephrine) was given and whether patients were intubated. Neither in total nor in any subgroup did we find results indicating beneficial effects of any of these two interventions. Whether treatment with adrenaline (epinephrine) or intubation will increase survival after out-of-hospital cardiac arrest needs to be confirmed in prospective randomised trials. (C) 2002 Published by Elsevier Science Ireland Ltd.