Hubble Michael W, Johnson Christopher, Blackwelder Jamie, Collopy Kevin, Houston Sara, Martin Melisa, Wilkes Delbert, Wiser Jonina
Prehosp Emerg Care. 2015;19(4):457-63. doi: 10.3109/10903127.2015.1005262. Epub 2015 Apr 24.
Vasopressors (epinephrine and vasopressin) are associated with return of spontaneous circulation (ROSC). Recent retrospective studies reported a greater likelihood of ROSC when vasopressors were administered within the first 10 minutes of arrest. However, it is unlikely that the relationship between ROSC and the timing of vasopressor administration is a binary function (i.e., ≤10 vs. >10 minutes). More likely, this relationship is a function of time measured on a continuum, with diminishing effectiveness even within the first 10 minutes of arrest, and potentially, some lingering benefit beyond 10 minutes. However, this relationship remains undefined.
To develop a model describing the likelihood of ROSC as a function of the call receipt to vasopressor interval (CRTVI) measured on a continuum.
We conducted a retrospective study of cardiac arrest using the North Carolina Prehospital Care Reporting System (PREMIS). Inclusionary criteria were all adult patients suffering a witnessed, nontraumatic arrest during January-June 2012. Chi-square and t-tests were used to analyze the relationships between ROSC and CRTVI; patient age, race, and gender; endotracheal intubation (ETI); automated external defibrillator (AED) use; presenting cardiac rhythm; and bystander cardiopulmonary resuscitation (CPR). A multivariate logistic regression model calculated the odds ratio (OR) of ROSC as a function of CRTVI while controlling for potential confounding variables.
Of the 1,122 patients meeting inclusion criteria, 542 (48.3%) experienced ROSC. ROSC was less likely with increasing CRTVI (OR = 0.96, p < 0.01). Compared to patients with shockable rhythms, patients with asystole (OR = 0.42, p < 0.01) and pulseless electrical activity (OR = 0.52, p < 0.01) were less likely to achieve ROSC. Males (OR = 0.64, p = 0.02) and patients receiving bystander CPR (OR = 0.42, p < 0.01) were less likely to attain ROSC, although emergency medical services response times were significantly longer among patients receiving bystander CPR. Race, age, ETI, and AED were not predictors of ROSC.
We found that time to vasopressor administration is significantly associated with ROSC, and the odds of ROSC declines by 4% for every 1-minute delay between call receipt and vasopressor administration. These results support the notion of a time-dependent function of vasopressor effectiveness across the entire range of administration delays rather than just the first 10 minutes. Large, prospective studies are needed to determine the relationship between the timing of vasopressor administration and long-term outcomes.
血管升压药（肾上腺素和血管加压素）与自主循环恢复（ROSC）相关。近期回顾性研究表明，在心脏骤停的前10分钟内给予血管升压药时，自主循环恢复的可能性更大。然而，自主循环恢复与血管升压药给药时间之间的关系不太可能是二元函数（即≤10分钟与>10分钟）。更有可能的是，这种关系是连续测量时间的函数，即使在心脏骤停的前10分钟内效果也会逐渐减弱，并且在10分钟后可能仍有一些持续的益处。然而，这种关系仍不明确。
建立一个模型，描述自主循环恢复的可能性作为连续测量的呼叫接收至血管升压药间隔时间（CRTVI）的函数。
我们使用北卡罗来纳州院前护理报告系统（PREMIS）对心脏骤停进行了一项回顾性研究。纳入标准为2012年1月至6月期间所有发生目击、非创伤性心脏骤停的成年患者。使用卡方检验和t检验分析自主循环恢复与CRTVI之间的关系；患者的年龄、种族和性别；气管插管（ETI）；自动体外除颤器（AED）的使用；初始心律；以及旁观者心肺复苏（CPR）。多变量逻辑回归模型在控制潜在混杂变量的同时，计算自主循环恢复的比值比（OR）作为CRTVI的函数。
在1122名符合纳入标准的患者中，542名（48.3%）实现了自主循环恢复。随着CRTVI的增加，自主循环恢复的可能性降低（OR = 0.96，p < 0.01）。与可除颤心律的患者相比，心搏停止（OR = 0.42，p < 0.01）和无脉电活动（OR = 0.52，p < 0.01）的患者实现自主循环恢复的可能性较小。男性（OR = 0.64，p = 0.02）和接受旁观者心肺复苏的患者（OR = 0.42，p < 0.01）实现自主循环恢复的可能性较小，尽管接受旁观者心肺复苏的患者的紧急医疗服务响应时间明显更长。种族、年龄、气管插管和自动体外除颤器不是自主循环恢复的预测因素。
我们发现血管升压药给药时间与自主循环恢复显著相关，呼叫接收至血管升压药给药之间每延迟1分钟，自主循环恢复的几率下降4%。这些结果支持血管升压药有效性在整个给药延迟范围内是时间依赖性函数的观点，而不仅仅是在前10分钟内。需要进行大型前瞻性研究来确定血管升压药给药时间与长期预后之间的关系。
