Brown C G, Martin D R, Pepe P E, Stueven H, Cummins R O, Gonzalez E, Jastremski M
Department of Emergency Medicine, Ohio State University, Columbus 43210.
N Engl J Med. 1992 Oct 8;327(15):1051-5. doi: 10.1056/NEJM199210083271503.
Experimental and uncontrolled clinical evidence suggests that intravenous epinephrine in doses higher than currently recommended may improve outcome after cardiac arrest. We conducted a prospective, multicenter study comparing standard-dose epinephrine with high-dose epinephrine in the management of cardiac arrest outside the hospital.
Adult patients were enrolled in the study if they remained in ventricular fibrillation, or if they had asystole or electromechanical dissociation, at the time the first drug was to be administered to treat the cardiac arrest. Patients were randomly assigned to receive either 0.02 mg of epinephrine per kilogram of body weight (standard-dose group, 632 patients) or 0.2 mg per kilogram (high-dose group, 648 patients), both given intravenously.
In the standard-dose group 190 patients (30 percent) had a return of spontaneous circulation, as compared with 217 patients (33 percent) in the high-dose group; 136 patients (22 percent) in the standard-dose group and 145 patients (22 percent) in the high-dose group survived to be admitted to the hospital. Twenty-six patients (4 percent) in the standard-dose group and 31 (5 percent) in the high-dose group survived to discharge from the hospital. Ninety-two percent of the patients discharged in the standard-dose group and 94 percent in the high-dose group were conscious at the time of hospital discharge. None of the differences in outcome between the groups were statistically significant.
In this study, we were unable to demonstrate any difference in the overall rate of return of spontaneous circulation, survival to hospital admission, survival to hospital discharge, or neurologic outcome between patients treated with a standard dose of epinephrine and those treated with a high dose.
实验性及非对照临床证据表明，静脉注射剂量高于当前推荐剂量的肾上腺素可能改善心脏骤停后的预后。我们开展了一项前瞻性多中心研究，比较标准剂量肾上腺素与高剂量肾上腺素用于院外心脏骤停处理的效果。
成年患者若在首次使用药物治疗心脏骤停时仍处于心室颤动状态，或存在心搏停止或电机械分离，则纳入本研究。患者被随机分配接受每千克体重0.02毫克肾上腺素（标准剂量组，632例患者）或每千克体重0.2毫克肾上腺素（高剂量组，648例患者），均通过静脉注射给药。
标准剂量组有190例患者（30%）恢复自主循环，高剂量组为217例患者（33%）；标准剂量组有136例患者（22%）存活至入院，高剂量组为145例患者（22%）。标准剂量组有26例患者（4%）存活至出院，高剂量组为31例患者（5%）。标准剂量组出院患者中有92%在出院时意识清醒，高剂量组为94%。两组间的预后差异均无统计学意义。
在本研究中，我们未能证明接受标准剂量肾上腺素治疗的患者与接受高剂量肾上腺素治疗的患者在自主循环恢复总率、存活至入院、存活至出院或神经学预后方面存在任何差异。
