Sagisaka R, Tanaka H, Takyu H, Ueta H, Tanaka S
Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan.
Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan.
Am J Emerg Med. 2017 Oct;35(10):1462-1468. doi: 10.1016/j.ajem.2017.04.052. Epub 2017 May 2.
Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered.
The aim of the study was to analyze the effects of repeated epinephrine administration after OHCA on favorable cerebral function coded by cerebral performance categories (CPC 1-2).
A nationwide, retrospective, population-based observational study was conducted by using Utstein-style data between 2010 and 2012 in Japan. The total of 11,876 cardiogenic and witnessed OHCA were stratified into 3 categories by the number of times epinephrine was administered (single, double, and three or more). In addition, the time elapsed between the emergency call and the initial epinephrine administration was divided into 3 time intervals (5 to 20min for the early administration group [EAG], 21 to 26min for the intermediate administration group [IAG], and 27 to 60min for the late administration group [LAG]). The primary endpoint was CPC 1-2 at 1month after cardiac arrest. A multivariable logistic regression was used for analysis.
Achievement of CPC 1-2 at 1month was 4.8% for single, 2.4% for double, and 1.7% for three or more administered doses. For single and three or more administrations, CPC 1-2 was significantly higher in the IAG than in the LAG (adjusted odds ratio [AOR], 3.54, 3.02; 95% confidence interval [CI], 2.04-6.39, 1.16-9.43, for single and three or more administrations, respectively). The EAG showed significantly higher achievement of CPC 1-2 in all the epinephrine administration groups (AOR, 9.26, 7.57, 4.07; 95% CI, 5.44-16.59, 3.39-19.60, 1.59-12.69, for single, double, and three or more administrations, respectively).
Repeated epinephrine administration improved CPC 1-2 outcome when epinephrine was administrated within 20min after an emergency call for witnessed cardiogenic OHCA.
院外心脏骤停（OHCA）后重复使用肾上腺素与不良脑结局相关，但尚未考虑肾上腺素的给药时机。
本研究旨在分析OHCA后重复使用肾上腺素对按脑功能分级（CPC 1-2）编码的良好脑功能的影响。
利用日本2010年至2012年的Utstein式数据进行了一项全国性、回顾性、基于人群的观察性研究。11876例心源性且有目击者的OHCA患者按肾上腺素给药次数分为3类（单次、两次、三次及以上）。此外，将紧急呼叫至首次使用肾上腺素的时间分为3个时间段（早期给药组[EAG]为5至20分钟，中间给药组[IAG]为21至26分钟，晚期给药组[LAG]为27至60分钟）。主要终点是心脏骤停后1个月时的CPC 1-2。采用多变量逻辑回归进行分析。
单次给药1个月时达到CPC 1-2的比例为4.8%，两次给药为2.4%，三次及以上给药为1.7%。对于单次和三次及以上给药，IAG组的CPC 1-2显著高于LAG组（调整优势比[AOR]分别为3.54和3.02；95%置信区间[CI]分别为2.04 - 6.39和1.16 - 9.43）。在所有肾上腺素给药组中，EAG组达到CPC 1-2的比例显著更高（单次、两次、三次及以上给药的AOR分别为9.26、7.57、4.07；95%CI分别为5.44 - 16.59、3.39 - 19.60、1.59 - 12.69）。
对于有目击者的心源性OHCA，在紧急呼叫后20分钟内使用肾上腺素时，重复使用肾上腺素可改善CPC 1-2结局。
