A COMPARISON OF STANDARD-DOSE AND HIGH-DOSE EPINEPHRINE IN CARDIAC-ARREST OUTSIDE THE HOSPITAL
A COMPARISON OF STANDARD-DOSE AND HIGH-DOSE EPINEPHRINE IN CARDIAC-ARREST OUTSIDE THE HOSPITAL
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DOI：
10.1056/nejm199210083271503
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发表时间：
1992-10-08
影响因子：
158.5
通讯作者：
JASTREMSKI, M
中科院分区：
文献类型：
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作者：
BROWN, CG;MARTIN, DR;JASTREMSKI, M
背景实验和非对照临床证据表明，静脉注射肾上腺素的剂量高于目前推荐的可能会改善心脏骤停后的结果。我们进行了一项前瞻性、多中心研究，比较标准剂量肾上腺素和大剂量肾上腺素在院外心脏骤停治疗中的作用。如果在给予第一种药物治疗心脏骤停时，成人患者仍处于室颤状态，或者如果他们有心搏停止或机电分离，则入组研究。患者被随机分配接受0.02 mg/kg体重的肾上腺素（标准剂量组，632例）或0.2 mg/kg体重的肾上腺素（高剂量组，648例），均静脉注射。在标准剂量组中，190名患者（30%）恢复了自主循环，而高剂量组中有217名患者（33%）;标准剂量组中有136名患者（22%）和高剂量组中有145名患者（22%）存活到住院。标准剂量组有26名患者（4%），高剂量组有31名患者（5%）存活出院。标准剂量组和高剂量组分别有92%和94%的患者在出院时意识清醒。两组之间的结果差异无统计学意义。在这项研究中，我们无法证明接受标准剂量肾上腺素治疗的患者与接受高剂量肾上腺素治疗的患者在自主循环的总体恢复率、住院生存率、出院生存率或神经系统结局方面存在任何差异。
Background. Experimental and uncontrolled clinical evidence suggests that intravenous epinephrine in doses higher than currently recommended may improve outcome after cardiac arrest. We conducted a prospective, multicenter study comparing standard-dose epinephrine with high-dose epinephrine in the management of cardiac arrest outside the hospital.Methods. Adult patients were enrolled in the study if they remained in ventricular fibrillation, or if they had asystole or electromechanical dissociation, at the time the first drug was to be administered to treat the cardiac arrest. Patients were randomly assigned to receive either 0.02 mg of epinephrine per kilogram of body weight (standard-dose group, 632 patients) or 0.2 mg per kilogram (high-dose group, 648 patients), both given intravenously.Results. In the standard-dose group 190 patients (30 percent) had a return of spontaneous circulation, as compared with 217 patients (33 percent) in the high-dose group; 136 patients (22 percent) in the standard-dose group and 145 patients (22 percent) in the high-dose group survived to be admitted to the hospital. Twenty-six patients (4 percent) in the standard-dose group and 31 (5 percent) in the high-dose group survived to discharge from the hospital. Ninety-two percent of the patients discharged in the standard-dose group and 94 percent in the high-dose group were conscious at the time of hospital discharge. None of the differences in outcome between the groups were statistically significant.Conclusions. In this study, we were unable to demonstrate any difference in the overall rate of return of spontaneous circulation, survival to hospital admission, survival to hospital discharge, or neurologic outcome between patients treated with a standard dose of epinephrine and those treated with a high dose.