Callaham M, Madsen C D, Barton C W, Saunders C E, Pointer J
Division of Emergency Medicine, University of California, San Francisco.
JAMA. 1992 Nov 18;268(19):2667-72.
To determine the relative efficacy of high- vs standard-dose catecholamines in initial treatment of prehospital cardiac arrest.
Randomized, prospective, double-blind clinical trial.
Prehospital emergency medical system of a major US city.
All adults in nontraumatic cardiac arrest, treated by paramedics, who would receive epinephrine according to American Heart Association advanced cardiac life support guidelines.
High-dose epinephrine (HDE, 15 mg), high-dose norepinephrine bitartrate (NE, 11 mg), or standard-dose epinephrine (SDE, 1 mg) was blindly substituted for advanced cardiac life support doses of epinephrine.
Restoration of spontaneous circulation in the field, admission to hospital, hospital discharge, and Cerebral Performance Category score.
Of 2694 patients with cardiac arrests during the study period, resuscitation was attempted on 1062 patients. Of this total, 816 patients met study criteria and were enrolled. In the entire cardiac arrest population, 63% of the survivors were among the 11% of patients who were defibrillated by first responders. The three drug treatment groups were similar for all independent variables. Thirteen percent of patients receiving HDE regained a pulse in the field vs 8% of those receiving SDE (P = .01), and 18% of HDE patients were admitted to the hospital vs 10% of SDE patients who were admitted to the hospital (P = .02). Similar trends for NE were not significant. There were 18 survivors; 1.7% of HDE patients and 2.6% of NE patients were discharged from the hospital compared with 1.2% of SDE patients, but this was not significant (P = .37; beta = .38). There was a nonsignificant trend for Cerebral Performance Category scores to be worse for HDE (3.2) and NE patients (3.7) than for SDE patients (2.3) (P = .10; beta = .31). No significant complications were identified. High-dose epinephrine did not produce longer hospital or critical care unit stays.
High-dose epinephrine significantly improves the rate of return of spontaneous circulation and hospital admission in patients who are in prehospital cardiac arrest without increasing complications. However, the increase in hospital discharge rate is not statistically significant, and no significant trend could be determined for neurological outcome. No benefit of NE compared with HDE was identified. Further study is needed to determine the optimal role of epinephrine in prehospital cardiac arrest.
确定高剂量与标准剂量儿茶酚胺在院前心脏骤停初始治疗中的相对疗效。
随机、前瞻性、双盲临床试验。
美国一个主要城市的院前急救医疗系统。
所有非创伤性心脏骤停的成年患者，由护理人员治疗，且根据美国心脏协会高级心脏生命支持指南将接受肾上腺素治疗。
将高剂量肾上腺素（HDE，15毫克）、高剂量重酒石酸去甲肾上腺素（NE，11毫克）或标准剂量肾上腺素（SDE，1毫克）盲目替代高级心脏生命支持剂量的肾上腺素。
现场自主循环恢复、入院、出院及脑功能分类评分。
在研究期间的2694例心脏骤停患者中，对1062例患者进行了复苏尝试。其中，816例患者符合研究标准并被纳入。在整个心脏骤停人群中，63%的幸存者来自急救人员首次除颤的11%患者中。三个药物治疗组在所有独立变量方面相似。接受HDE的患者中有13%在现场恢复了脉搏，而接受SDE的患者为8%（P = 0.01），接受HDE的患者中有18%入院，而接受SDE入院的患者为10%（P = 0.02）。NE的类似趋势不显著。有18例幸存者；接受HDE的患者中有1.7%、接受NE的患者中有2.6%出院，而接受SDE的患者为1.2%，但差异无统计学意义（P = 0.37；β = 0.38）。HDE（3.2）和NE患者（3.7）的脑功能分类评分比SDE患者（2.3）差，差异无统计学意义（P = 0.10；β = 0.31）。未发现显著并发症。高剂量肾上腺素未导致住院或重症监护病房住院时间延长。
高剂量肾上腺素可显著提高院前心脏骤停患者的自主循环恢复率和入院率，且不增加并发症。然而，出院率的增加无统计学意义，且未确定神经功能转归的显著趋势。未发现NE与HDE相比有任何益处。需要进一步研究以确定肾上腺素在院前心脏骤停中的最佳作用。
