Effects of prehospital epinephrine during out-of-hospital cardiac arrest with initial non-shockable rhythm: An observational cohort study
Critical Care 2013, 17: R188
© Gary Wilson/ Pre-hospital Research Forum
Few clinical trials have provided evidence that epinephrine administration after out-of-hospital cardiac arrest (OHCA) improves long-term survival. Here the authors determined whether prehospital epinephrine administration would improve 1-month survival in OHCA patients.
Methods: The authors analysed the data of 209,577 OHCA patients; the data were prospectively collected in a nationwide Utstein-style Japanese database between 2009 and 2010. Patients were divided into the initial shockable rhythm (n=15,492) and initial non-shockable rhythm (n=194,085) cohorts. The endpoints were prehospital return of spontaneous circulation (ROSC), 1-month survival, and 1-month favourable neurological outcomes (cerebral performance category scale, category 1 or 2) after OHCA. The authors defined epinephrine administration time as the time from the start of cardiopulmonary resuscitation (CPR) by emergency medical services personnel to the first epinephrine administration.
Results: In the initial shockable rhythm cohort, the ratios of prehospital ROSC, 1-month survival, and 1-month favorable neurological outcomes in the non-epinephrine group were significantly higher than those in the epinephrine group (27.7% vs. 22.8%, 27.0% vs. 15.4%, and 18.6% vs. 7.0%, respectively). However, in the initial non-shockable rhythm cohort, the ratios of prehospital ROSC and 1-month survival in the epinephrine group were significantly higher than those in the non-epinephrine group (18.7% vs. 3.0% and 3.9% vs. 2.2%, respectively) and there was no significant difference between the epinephrine and non-epinephrine groups for 1-month favorable neurological outcomes. Prehospital epinephrine administration for OHCA patients with initial non-shockable rhythms was independently associated with prehospital ROSC with improved 1-month survival when epinephrine administration time was <20 min, and with deteriorated 1-month favorable neurological outcomes.
Conclusions: Prehospital epinephrine administration for OHCA patients with initial non-shockable rhythms was independently associated with achievement of prehospital ROSC and had association with improved 1-month survival when epinephrine administration time was <20 min.
http://ccforum.com/content/pdf/cc12872.pdf (full article)