Funada Akira, Goto Yoshikazu, Tada Hayato, Shimojima Masaya, Hayashi Kenshi, Kawashiri Masa-Aki, Yamagishi Masakazu
Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
Heart Vessels. 2018 Dec;33(12):1525-1533. doi: 10.1007/s00380-018-1205-6. Epub 2018 Jun 23.
The effects of prehospital epinephrine administration on post-arrest neurological outcome in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm remain unclear. To examine the time-dependent effectiveness of prehospital epinephrine administration, we analyzed 118,396 bystander-witnessed OHCA patients with non-shockable rhythm from the prospectively recorded all-Japan OHCA registry between 2011 and 2014. Patients who achieved prehospital return of spontaneous circulation without prehospital epinephrine administration were excluded. Patients with prehospital epinephrine administration were stratified according to the time from the initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers to the first epinephrine administration (≤ 10, 11-19, and ≥ 20 min). Patients without prehospital epinephrine administration were stratified according to the time from CPR initiation by EMS providers to hospital arrival (≤ 10, 11-19, and ≥ 20 min). The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1-2). Multivariate logistic regression analysis demonstrated that there was no significant difference in the chance of 1-month CPC 1-2 between patients who arrived at hospital in ≤ 10 min without prehospital epinephrine administration and patients with time to epinephrine administration ≤ 19 min. However, compared to patients who arrived at hospital in ≤ 10 min without prehospital epinephrine administration, patients with time to epinephrine administration ≥ 20 min and patients who arrived at hospital in 11-19, and ≥ 20 min without prehospital epinephrine administration were significantly associated with decreased chance of 1-month CPC 1-2 (p < 0.05, < 0.05, and < 0.001, respectively). In conclusion, when prehospital CPR duration from CPR initiation by EMS providers to hospital arrival estimated to be ≥ 11 min, prehospital epinephrine administered ≤ 19 min from CPR initiation by EMS providers could improve neurologically intact survival in bystander-witnessed OHCA patients with non-shockable rhythm.
对于院外心脏骤停（OHCA）且心律不可电击复律的患者，院外给予肾上腺素对心脏骤停后神经功能转归的影响尚不清楚。为了研究院外给予肾上腺素的时间依赖性效果，我们分析了2011年至2014年期间前瞻性记录的全日本OHCA登记处的118396例由旁观者见证的OHCA且心律不可电击复律的患者。排除在未给予院外肾上腺素的情况下实现院外自主循环恢复的患者。给予院外肾上腺素的患者根据从紧急医疗服务（EMS）人员开始心肺复苏（CPR）到首次给予肾上腺素的时间进行分层（≤10分钟、11 - 19分钟和≥20分钟）。未给予院外肾上腺素的患者根据EMS人员开始CPR到医院到达的时间进行分层（≤10分钟、11 - 19分钟和≥20分钟）。主要结局是1个月时神经功能完好存活（脑功能分类1或2；CPC 1 - 2）。多因素逻辑回归分析表明，在未给予院外肾上腺素且在≤10分钟内到达医院的患者与给予肾上腺素时间≤19分钟的患者之间，1个月时CPC 1 - 2的可能性没有显著差异。然而，与未给予院外肾上腺素且在≤10分钟内到达医院的患者相比，给予肾上腺素时间≥20分钟的患者以及未给予院外肾上腺素且在11 - 19分钟和≥20分钟内到达医院的患者，1个月时CPC 1 - 2的可能性显著降低（分别为p < 0.05、< 0.05和< 0.001）。总之，当估计从EMS人员开始CPR到医院到达的院外CPR持续时间≥11分钟时，在EMS人员开始CPR后≤19分钟给予院外肾上腺素可改善由旁观者见证的OHCA且心律不可电击复律患者的神经功能完好存活情况。
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