Fujii Tomoko, Kitamura Tetsuhisa, Kajino Kentaro, Kiyohara Kosuke, Nishiyama Chika, Nishiuchi Tatsuya, Hayashi Yasuyuki, Kawamura Takashi, Iwami Taku
Epidemiology and Preventive Medicine, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan.
BMJ Open. 2017 Dec 1;7(12):e015055. doi: 10.1136/bmjopen-2016-015055.
Prehospital intravenous access is a common intervention for patients with out-of-hospital cardiac arrest (OHCA). We aimed to assess the effectiveness of prehospital intravenous access and subsequent epinephrine administration on outcomes among OHCA patients.
We conducted a prospective cohort study of patients with OHCA from non-traumatic causes aged ≥18 years in Osaka, Japan from January 2005 through December 2012. The primary outcome was 1-month survival with favourable neurological outcome defined as a cerebral performance category of 1 or 2. The association between intravenous line placement and survival with favourable neurological outcome was evaluated by logistic regression, after propensity score matching for the intravenous access attempt stratified by initial documented rhythm of ventricular fibrillation (VF) or non-VF. The contribution of epinephrine administration to the outcome was also explored.
Among OHCA patients during the study period, 3208 VF patients and 38 175 non-VF patients were included in our analysis. Intravenous access attempt was negatively associated with 1-month survival with a favourable neurological outcome in VF group (OR 0.76, 95% CI 0.59 to 0.98), while no association was observed in the non-VF group (OR 1.06, 95% CI 0.84 to 1.34). Epinephrine administration had no positive association in the VF patients (OR 0.75, 95% CI 0.51 to 1.07) and positively associated in the non-VF patients (OR 1.52, 95% CI 1.08 to 2.08) with the favourable neurological outcome.
Intravenous access attempt could be negatively associated with survival with a favourable neurological outcome after OHCA. Subsequent epinephrine administration might be effective for non-VF OHCAs.
院外心脏骤停（OHCA）患者的院前静脉通路建立是一种常见的干预措施。我们旨在评估院前静脉通路建立及随后给予肾上腺素对OHCA患者预后的有效性。
我们对2005年1月至2012年12月在日本大阪年龄≥18岁的非创伤性病因导致的OHCA患者进行了一项前瞻性队列研究。主要结局是1个月存活且神经功能预后良好，定义为脑功能分类为1或2。在根据初始记录的室颤（VF）或非VF节律对静脉通路尝试进行倾向评分匹配后，通过逻辑回归评估静脉置管与存活且神经功能预后良好之间的关联。还探讨了肾上腺素给药对结局的影响。
在研究期间的OHCA患者中，3208例VF患者和38175例非VF患者纳入我们的分析。在VF组中，静脉通路尝试与1个月存活且神经功能预后良好呈负相关（OR 0.76，95%CI 0.59至0.98），而在非VF组中未观察到关联（OR 1.06，95%CI 0.84至1.34）。肾上腺素给药在VF患者中与良好神经功能预后无正相关（OR 0.75，95%CI 0.51至1.07），而在非VF患者中呈正相关（OR 1.52，95%CI 1.08至2.08）。
OHCA后静脉通路尝试可能与存活且神经功能预后良好呈负相关。随后给予肾上腺素可能对非VF的OHCA有效。
