Department of Emergency Medicine, Reading Hospital, West Reading, PA, United States.
Department of Emergency Medicine, Reading Hospital, West Reading, PA, United States.
Resuscitation. 2019 Jun;139:182-188. doi: 10.1016/j.resuscitation.2019.04.018. Epub 2019 Apr 13.
The 2015 ILCOR Advanced Cardiovascular Life Support Guidelines recommend intravenous adrenaline (epinephrine) as a crucial pharmacologic treatment during cardiac arrest resuscitation. Some recent observational studies and clinical trials have questioned the efficacy of its use and suggested possible deleterious effects on overall survival and long-term outcomes. This study aimed to describe the association between time and dose of adrenaline on return of spontaneous circulation (ROSC) and neurologic function.
We performed a retrospective analysis of the Penn Alliance for Therapeutic Hypothermia (PATH) data registry. The timing of the first dose of adrenaline and the total dose of adrenaline during cardiac arrests was compared between survivors to discharge and non-survivors for arrests lasting greater than 10 min.
The registry contained 5594 patients. After excluding patients with an in-hospital cardiac arrest, a non-shockable rhythm, or no adrenaline administration, 1826 were included in the final analysis. Survivors to discharge received adrenaline sooner (median 5.0 vs. 7.0 min, p = 0.022) and required a lower total dose than non-survivors (2.0 vs. 3.0 mg, p < 0.001). For survivors, there was no significant association between the time to first adrenaline dose and favorable neurological outcome as measured by Cerebral Performance Category (CPC). Among survivors, those that received less than 2 mg of adrenaline had a more favorable neurologic outcome than those administered > 3 mg. (CPC 1-2 16.6% vs. 12.5%, p = 0.004).
Early adrenaline administration is associated with a higher percentage of survival to discharge but not associated with favorable neurological outcome. Those patients with a favorable neurologic outcome received a lower total adrenaline dose prior to ROSC.
2015 年国际复苏联络委员会（ILCOR）高级心血管生命支持指南建议在心脏骤停复苏期间静脉内给予肾上腺素（epinephrine）作为关键的药物治疗。一些最近的观察性研究和临床试验对其使用的疗效提出了质疑，并暗示其对总体存活率和长期结果可能存在有害影响。本研究旨在描述肾上腺素的给药时间和剂量与自主循环恢复（ROSC）和神经功能之间的关系。
我们对宾夕法尼亚联盟治疗性低温（PATH）数据登记处进行了回顾性分析。在持续时间大于 10 分钟的心脏骤停中，将幸存者出院与非幸存者出院的首次肾上腺素剂量和心脏骤停期间的肾上腺素总剂量进行比较。
该登记处包含 5594 名患者。排除院内心脏骤停、非除颤性节律或未给予肾上腺素的患者后，最终有 1826 名患者纳入最终分析。幸存者出院时更早接受肾上腺素治疗（中位数 5.0 分钟 vs. 7.0 分钟，p=0.022），且总剂量低于非幸存者（2.0 毫克 vs. 3.0 毫克，p<0.001）。对于幸存者，首次给予肾上腺素的时间与以脑功能预后评分（Cerebral Performance Category，CPC）衡量的良好神经功能结局之间无显著相关性。在幸存者中，接受少于 2 毫克肾上腺素的患者神经功能结局较好，而接受大于 3 毫克肾上腺素的患者神经功能结局较差（CPC 1-2 为 16.6% vs. 12.5%，p=0.004）。
早期给予肾上腺素与出院存活率的提高百分比相关，但与良好的神经功能结局无关。那些神经功能预后良好的患者在 ROSC 之前接受了较低的总肾上腺素剂量。
