Effects of prehospital epinephrine during out-of-hospital cardiac arrest with initial non-shockable rhythm: an observational cohort study

摘要: Few clinical trials have provided evidence that epinephrine administration after out-of-hospital cardiac arrest (OHCA) improves long-term survival. Here we determined whether prehospital would improve 1-month survival in OHCA patients. We analyzed the data of 209,577 patients; were prospectively collected a nationwide Utstein-style Japanese database between 2009 and 2010. Patients divided into initial shockable rhythm (n = 15,492) non-shockable 194,085) cohorts. The endpoints return spontaneous circulation (ROSC), survival, favorable neurological outcomes (cerebral performance category scale, 1 or 2) OHCA. defined time as from start cardiopulmonary resuscitation (CPR) by emergency medical services personnel to first administration. In cohort, ratios ROSC, non-epinephrine group significantly higher than those (27.7% vs. 22.8%, 27.0% 15.4%, 18.6% 7.0%, respectively; all P < 0.001). However, ROSC (18.7% 3.0% 3.9% 2.2%, 0.001) there was no significant difference groups for (P 0.62). Prehospital patients with rhythms independently associated (adjusted odds ratio [aOR], 8.83, 6.18, 4.32; 95% confidence interval [CI], 8.01-9.73, 5.82-6.56, 3.98-4.69; times ≤9 min, 10-19 ≥20 respectively), improved when <20 min (aOR, 1.78, 1.29; CI, 1.50-2.10, 1.17-1.43; deteriorated 0.63, 0.49; 0.48-0.80, 0.32-0.71; respectively). nonshockable achievement had association min.