Wang Chih-Hung, Huang Chien-Hua, Chang Wei-Tien, Tsai Min-Shan, Yu Ping-Hsun, Wu Yen-Wen, Hung Kuan-Yu, Chen Wen-Jone
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Resuscitation. 2016 Jun;103:125-130. doi: 10.1016/j.resuscitation.2015.12.008. Epub 2015 Dec 29.
To investigate the influence of dosing frequency and dosage of adrenaline on outcomes of cardiopulmonary resuscitation (CPR).
We conducted a retrospective observational study in a single medical centre and included adult patients who had suffered an in-hospital cardiac arrest between 2006 and 2012. We used multivariable logistic regression analysis to evaluate the associations between independent variables and outcomes. Adrenaline average dosing frequency was calculated as the total dosage of adrenaline administered during CPR divided by the duration of CPR. Body weight (BW) was analysed as an interaction term to investigate the effect of adrenaline dosage on outcomes. Favourable neurological outcome was defined as a score of 1 or 2 on the Cerebral Performance Category scale at hospital discharge.
We included 896 patients in the analysis. After adjusting for multiple confounding factors, including CPR duration, the results indicated that higher adrenaline dosing frequency was associated with lower rates of survival (odds ratio (OR): 0.05, 95% confidence interval (CI): 0.01-0.23) and favourable neurological outcome at hospital discharge (OR: 0.02, 95% CI: 0.002-0.16). A significant interaction was noted between total adrenaline dosage and BW, which indicated that, with the same adrenaline dosage, the outcomes for patients with BW≥82.5kg would be worse than those for patients with lower BW.
Higher adrenaline average dosing frequency may be associated with worse outcomes after CPR. Besides, according to current recommendations, patients with BW above 82.5kg may not receive adequate dose of adrenaline.
探讨肾上腺素给药频率和剂量对心肺复苏（CPR）结局的影响。
我们在一家单一医疗中心进行了一项回顾性观察研究，纳入了2006年至2012年间发生院内心脏骤停的成年患者。我们使用多变量逻辑回归分析来评估自变量与结局之间的关联。肾上腺素平均给药频率计算为CPR期间给予的肾上腺素总剂量除以CPR持续时间。将体重（BW）作为一个交互项进行分析，以研究肾上腺素剂量对结局的影响。良好的神经学结局定义为出院时脑功能分类量表评分为1或2分。
我们纳入了896例患者进行分析。在调整了包括CPR持续时间在内的多个混杂因素后，结果表明，较高的肾上腺素给药频率与较低的生存率（比值比（OR）：0.05，95%置信区间（CI）：0.01 - 0.23）和出院时良好的神经学结局（OR：0.02，95%CI：0.002 - 0.16）相关。在肾上腺素总剂量和BW之间观察到显著的交互作用，这表明，在肾上腺素剂量相同的情况下，BW≥82.5kg患者的结局比BW较低患者的结局更差。
较高的肾上腺素平均给药频率可能与CPR后更差的结局相关。此外，根据当前建议，BW超过82.5kg的患者可能未接受足够剂量的肾上腺素。
