Epinephrine administration for adult out-of-hospital cardiac arrest patients with refractory shockable rhythm: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry
Epinephrine administration for adult out-of-hospital cardiac arrest patients with refractory shockable rhythm: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry
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DOI：
10.1093/ehjcvp/pvab013
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发表时间：
2021-02-23
影响因子：
7.1
通讯作者：
Kitamura, Tetsuhisa
中科院分区：
文献类型：
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作者：
Matsuyama, Tasuku;Komukai, Sho;Kitamura, Tetsuhisa
目的：对于院外心脏骤停（OHCA）患者首次除颤不成功，院前给予肾上腺素的效果知之甚少。方法和结果本研究使用日本全国范围内基于人群的登记研究，纳入了2014年1月至2017年12月期间年龄≥ 18岁且患有难治性可电击心律的所有成人OHCA患者。在心脏骤停期间使用或不使用肾上腺素的患者在同一分钟内使用基于时间依赖性倾向评分的风险集匹配进行顺序匹配。主要结局是1个月生存率。次要结局包括1个月生存率和良好的神经功能结局（脑功能分类量表：1或2）和院前自主循环恢复（ROSC）。在研究期间数据库中登记的499944例患者中，纳入了22877例。其中，8467例（37.0%）接受了肾上腺素治疗。经过时间依赖倾向评分序贯匹配后，16 798例患者被纳入匹配队列。在配对队列中，肾上腺素与1个月生存率呈正相关[肾上腺素：17.3%，（1454/8399）vs.无肾上腺素：14.6%（1224/8399）;经常资源1.22（95%置信区间，CI：1.13-1.32）]和院前ROSC [肾上腺素：22.2%（1868/8399）vs.无肾上腺素：10.7%（900/8399）; RR 2.07（95% CI：1.91-2.25）]。未观察到肾上腺素与有利的神经系统结局之间存在显著正相关[肾上腺素：7.8%（654/8399）vs.无肾上腺素：7.1%（611/8399）; RR 1.13（95% CI 0.998-1.27）]。结论：使用全国范围内基于人群的登记与时间依赖性倾向评分序贯匹配分析，院前肾上腺素给药的成人OHCA难治性电击心律患者与1个月生存率和院前ROSC呈正相关。
Aims Little is known about the effect of prehospital epinephrine administration in out-of-hospital cardiac arrest (OHCA) patients with refractory shockable rhythm, for whom initial defibrillation was unsuccessful. Methods and results This study using Japanese nationwide population-based registry included all adult OHCA patients aged >= 18 years with refractory shockable rhythm between January 2014 and December 2017. Patients with or without epinephrine during cardiac arrest were sequentially matched using a risk set matching based on the time-dependent propensity scores within the same minute. The primary outcome was 1-month survival. The secondary outcomes included 1-month survival with favourable neurological outcome (cerebral performance category scale: 1 or 2) and prehospital return of spontaneous circulation (ROSC). Of the 499 944 patients registered in the database during the study period, 22 877 were included. Among them, 8467 (37.0%) received epinephrine. After time-dependent propensity score-sequential matching, 16 798 patients were included in the matched cohort. In the matched cohort, positive associations were observed between epinephrine and 1-month survival [epinephrine: 17.3% (1454/8399) vs. no epinephrine: 14.6% (1224/8399); RR 1.22 (95% confidence interval, CI: 1.13-1.32)] and prehospital ROSC [epinephrine: 22.2% (1868/8399) vs. no epinephrine: 10.7% (900/8399); RR 2.07 (95% CI: 1.91-2.25)]. No significant positive association was observed between epinephrine and favourable neurological outcome [epinephrine: 7.8% (654/8399) vs. no epinephrine: 7.1% (611/8399); RR 1.13 (95% CI 0.998-1.27)]. Conclusion Using the nationwide population-based registry with time-dependent propensity score-sequential matching analysis, prehospital epinephrine administration in adult OHCA patients with refractory shockable rhythm was positively associated with 1-month survival and prehospital ROSC.