Emergency Medical Care Program, Western Carolina University, Cullowhee, NC 28723, USA.
Prehosp Emerg Care. 2013 Jan-Mar;17(1):15-22. doi: 10.3109/10903127.2012.702193. Epub 2012 Jul 23.
Epinephrine and vasopressin are the only vasopressors associated with return of spontaneous circulation (ROSC). While current guidelines recommend rapid and frequent vasopressor administration during cardiac arrest, delays in their administration in the out-of- hospital setting remain a concern.
This study evaluated delays in vasopressor administration and their effect on field ROSC.
This retrospective review included all adult patients who experienced cardiac arrest of medical origin and received field resuscitative efforts among 10 emergency medical services (EMS) systems. Data were abstracted from the EMS medical record and included response time intervals, calculated first-dose and interdosing intervals of vasopressors, and ROSC. Data were analyzed using Mann-Whitney tests, chi-square tests, and t-tests, survival analysis, and logistic regression, with p ≤ 0.05 indicating significance.
A total of 660 cardiac arrest patients were enrolled in the study. The mean EMS response time was 8.8 minutes; 52.7% of patients had witnessed cardiac arrests, 46.2% received bystander cardiopulmonary resuscitation (CPR), 23.0% had shockable initial rhythms, and 19.5% experienced field ROSC. In total, 1,913 doses of epinephrine and 111 doses of vasopressin were administered, with mean and 90th-percentile scene arrival-to-first drug intervals of 9.5 and 17 minutes, respectively. The mean and 90th-percentile interdosing intervals were 6.1 and 10 minutes, respectively. Patients experiencing ROSC had shorter scene arrival-to-first drug intervals than those without ROSC (8.1 vs. 9.8 min, p < 0.01), but there was no difference in the mean interdosing interval (6.8 vs. 6.0 min, p = 0.57). In the logistic regression analysis of ROSC, the adjusted odds ratio for call receipt-to-first drug interval ≤10 minutes was 1.91 (p = 0.04). Patients receiving advanced airway control prior to vasopressor administration were less likely to have a call receipt-to-first drug interval within 10 minutes (4.0% vs. 17.3%, p < 0.01) and were less likely to attain ROSC (15.7% vs. 25.4%, p < 0.01).
The interval between scene arrival and first administration of vasopressors is significantly shorter among patients who experience ROSC compared with those who do not. Airway control procedures delay vasopressor administration and reduce the likelihood of ROSC. Although the interdosing intervals of most patients were not consistent with current recommendations, there was no difference in the mean interdosing times between those who achieved ROSC and those who did not.
肾上腺素和血管加压素是与自主循环恢复（ROSC）相关的唯一升压药。虽然目前的指南建议在心脏骤停期间快速频繁地给予升压药，但在院外环境中给予升压药的延迟仍然是一个问题。
本研究评估升压药给药延迟及其对现场 ROSC 的影响。
本回顾性研究纳入了在 10 个急救医疗服务（EMS）系统中接受现场复苏治疗的所有患有医学起源的心脏骤停的成年患者。数据从 EMS 病历中提取，包括反应时间间隔、计算的升压药首次剂量和间隔剂量间隔以及 ROSC。使用 Mann-Whitney 检验、卡方检验和 t 检验、生存分析和逻辑回归进行数据分析，p≤0.05 表示具有统计学意义。
共有 660 名心脏骤停患者入组本研究。EMS 反应时间的平均值为 8.8 分钟；52.7%的患者发生目击性心脏骤停，46.2%接受旁观者心肺复苏（CPR），23.0%初始节律为可除颤，19.5%发生现场 ROSC。总共给予了 1913 剂肾上腺素和 111 剂血管加压素，到达现场的中位到达至首次给药时间分别为 9.5 和 17 分钟。平均和 90%百分位的间隔剂量间隔分别为 6.1 和 10 分钟。经历 ROSC 的患者到达现场的首次药物间隔时间短于未经历 ROSC 的患者（8.1 与 9.8 分钟，p<0.01），但间隔剂量间隔的平均值没有差异（6.8 与 6.0 分钟，p=0.57）。在 ROSC 的逻辑回归分析中，到达现场的药物间隔时间≤10 分钟的调整比值比为 1.91（p=0.04）。在接受升压药治疗前进行高级气道控制的患者，到达现场的药物间隔时间<10 分钟的可能性较低（4.0%与 17.3%，p<0.01），并且达到 ROSC 的可能性较低（15.7%与 25.4%，p<0.01）。
与未经历 ROSC 的患者相比，经历 ROSC 的患者到达现场与首次给予升压药之间的间隔时间明显更短。气道控制程序会延迟升压药的给予，并降低 ROSC 的可能性。尽管大多数患者的间隔剂量间隔时间不符合当前建议，但达到 ROSC 的患者与未达到 ROSC 的患者的平均间隔时间没有差异。
