The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest

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• 作者：Gordon A. Ewy^a ; ^b ; ^e ; ^{gaewy1933@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Bentley J. Bobrow^a ; ^g ; ^h ; Vatsal Chikani^h ; Arthur B. Sanders^a ; ^d ; ^g ; Charles W. Otto^a ; ^c ; ^f ; Daniel W. Spaite^d ; ^g ; Karl B. Kern^a ; ^b ; ^e
• 关键词：Cardiac arrest ; Epinephrine ; Emergency medical services ; Asystole ; Pulseless electrical activity ; Ventricular fibrillation
• 刊名：Resuscitation
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：96
• 期：Complete
• 页码：180-185
• 全文大小：553 K

文摘

Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial.

absSec_2">Purpose

ar0010">To investigate the possible time-dependent outcomes associated with adrenaline administration by Emergency Medical Services personnel (EMS).

absSec_3">Methods

ar0015">A retrospective analysis of prospectively collected data from a near statewide cardiac resuscitation database between 1 January 2005 and 30 November 2013. Multivariable logistic regression was used to analyze the effect of the time interval between EMS dispatch and the initial dose of adrenaline on survival. The primary endpoints were survival to hospital discharge and favourable neurologic outcome.

absSec_4">Results

ar0020">Data from 3469 patients with witnessed OHCA were analyzed. Their mean age was 66.3 years and 69% were male. An initially shockable rhythm was present in 41.8% of patients. Based on a multivariable logistic regression model with initial adrenaline administration time interval (AATI) from EMS dispatch as the covariate, survival was greatest when adrenaline was administered very early but decreased rapidly with increasing (AATI); odds ratio 0.94 (95% Confidence Interval (CI) 0.92–0.97). The AATI had no significant effect on good neurological outcome (OR = 0.96, 95% CI = 0.90–1.02).

absSec_5">Conclusions

ar0025">In patients with OHCA, survival to hospital discharge was greater in those treated early with adrenaline by EMS especially in the subset of patients with a shockable rhythm. However survival rapidly decreased with increasing adrenaline administration time intervals (AATI).