Ong Marcus Eng Hock, Tan Eng Hoe, Ng Faith Suan Peng, Panchalingham Anushia, Lim Swee Han, Manning Peter George, Ong Victor Yeok Kein, Lim Steven Hoon Chin, Yap Susan, Tham Lai Peng, Ng Kheng Siang, Venkataraman Anantharaman
Department of Emergency Medicine, Singapore General Hospital, Singapore City, Singapore.
Ann Emerg Med. 2007 Dec;50(6):635-42. doi: 10.1016/j.annemergmed.2007.03.028. Epub 2007 May 23.
The benefit of epinephrine in cardiac arrest is controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) system that previously did not use intravenous medications.
This observational, prospective, before-after clinical study constitutes phase II of the Cardiac Arrest and Resuscitation Epidemiology project. Included were all patients who are older than 8 years, with nontraumatic out-of-hospital cardiac arrest conveyed by the national emergency ambulance service. The comparison between the 2 intervention groups for survival to discharge was made with logistic regression and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI).
From October 1, 2002, to October 14, 2004, 1,296 patients were enrolled into the study, with 615 in the pre-epinephrine and 681 in the epinephrine phase. Demographic and EMS characteristics were similar in both groups. Forty-four percent of patients received intravenous epinephrine in the epinephrine phase. There was no significant difference in survival to discharge (pre-epinephrine 1.0%; epinephrine 1.6%; OR 1.7 [95% CI 0.6 to 4.5]; adjusted for rhythm OR 2.0 [95% CI 0.7 to 5.5]); return of circulation (pre-epinephrine 17.9%; epinephrine 15.7%; OR 0.9 [95% CI 0.6 to 1.2]), or survival to admission (pre-epinephrine 7.5%; epinephrine 7.5%; OR 1.0 [95% CI 0.7 to 1.5]). There was a minimal increase in scene time in the epinephrine phase (10.3 minutes versus 10.7 minutes; 95% CI of difference 0.02 to 0.94 minutes).
We were unable to establish a significant survival benefit with the introduction of intravenous epinephrine to an EMS system. More research is needed to determine the effectiveness of drugs such as epinephrine in resuscitation.
肾上腺素在心脏骤停治疗中的益处存在争议，尚未在任何人类临床研究中得到确凿证实。我们旨在评估在一个此前未使用静脉药物的紧急医疗服务（EMS）系统中，引入静脉注射肾上腺素对院外心脏骤停患者生存结局的影响。
这项观察性、前瞻性、前后对照的临床研究是心脏骤停与复苏流行病学项目的第二阶段。纳入的患者均为8岁以上，由国家紧急救护服务转运的非创伤性院外心脏骤停患者。通过逻辑回归对两个干预组的出院生存率进行比较，并以比值比（OR）和相应的95%置信区间（CI）表示。
从2002年10月1日至2004年10月14日，共有1296例患者纳入研究，其中肾上腺素使用前阶段615例，肾上腺素使用阶段681例。两组的人口统计学和EMS特征相似。在肾上腺素使用阶段，44%的患者接受了静脉注射肾上腺素。出院生存率（肾上腺素使用前1.0%；肾上腺素使用阶段1.6%；OR 1.7 [95% CI 0.6至4.5]；调整节律后OR 2.0 [95% CI 0.7至5.5]）、恢复自主循环率（肾上腺素使用前17.9%；肾上腺素使用阶段15.7%；OR 0.9 [95% CI 0.6至1.2]）或入院生存率（肾上腺素使用前7.5%；肾上腺素使用阶段7.5%；OR 1.0 [95% CI 0.7至1.5]）均无显著差异。肾上腺素使用阶段现场时间略有增加（10.3分钟对10.7分钟；差异的95% CI为0.02至0.94分钟）。
我们无法证实向EMS系统引入静脉注射肾上腺素能带来显著的生存获益。需要更多研究来确定肾上腺素等药物在复苏中的有效性。
