Lin Yan-Ren, Li Chao-Jui, Huang Cheng-Chieh, Lee Tsung-Han, Chen Tren-Yi, Yang Mei-Chueh, Chou Chu-Chung, Chang Chin-Fu, Huang Hsi-Wen, Hsu Hsiu-Ying, Chen Wen-Liang
Department of Emergency Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
Front Pediatr. 2019 Jun 6;7:220. doi: 10.3389/fped.2019.00220. eCollection 2019.
In children with non-shockable out-of-hospital cardiac arrest, early epinephrine (EE) might help to establish the return of spontaneous circulation (ROSC) and be associated with survival. In the present study, we aimed to analyze the effects of EE on outcomes and post-resuscitation hemodynamics in children with non-shockable OHCA. This was a retrospective analysis of data from 216 children (<19 years) who had suffered non-traumatic and non-shockable OHCA and received epinephrine for resuscitation (Jan 1, 2006-Dec 31, 2014). Demographics, pre-/in-hospital information, and the time to the first dose of epinephrine were recorded. Early post-resuscitation hemodynamics (the first hour after sustained ROSC), survival and good neurological outcomes (Pediatric Cerebral Performance Category Scales 1 or 2) were analyzed by the time to epinephrine-classified as early (EE): <15 min, intermediate (IE): 15-30 min, or late (LE): >30 min. Twenty-eight (13.0%) children survived to discharge, but only 17 (7.9%) had good neurological outcomes. In all, 41 (18.9%) children received EE; in comparison to IE and LE, this was significantly associated with tachycardia (73.9%) in the post-resuscitation period ( < 0.05). Tachycardia (OR: 7.41, 95% CI: 1.96-29.31) and hypertension (OR: 6.03, 95% CI: 1.85-13.77) were significantly associated with EE after adjusting for confounding factors. EE was also significantly associated with better overall outcomes than ME and LE (any ROSC, sustained ROSC, survival to the intensive care unit, admission, survival to discharge and good neurological outcomes, all < 0.05). EE helped to establish ROSC but was also associated with more tachycardia and hypertension in the early post-resuscitation period. In children with non-traumatic and non-shockable OHCA, EE was associated with a higher survival rate and better neurological outcomes than were ME and LE.
在非可电击心律的院外心脏骤停儿童中，早期使用肾上腺素（EE）可能有助于实现自主循环恢复（ROSC）并与生存相关。在本研究中，我们旨在分析EE对非可电击心律的院外心脏骤停（OHCA）儿童的预后及复苏后血流动力学的影响。这是一项对216名年龄小于19岁、发生非创伤性且非可电击心律的OHCA并接受肾上腺素进行复苏的儿童（2006年1月1日至2014年12月31日）的数据进行的回顾性分析。记录了人口统计学信息、院前/院内信息以及首次使用肾上腺素的时间。根据使用肾上腺素的时间将复苏后早期血流动力学（持续ROSC后的第一小时）、生存情况及良好神经功能预后（小儿脑功能分类量表1级或2级）分为早期（EE）：<15分钟、中期（IE）：15 - 30分钟或晚期（LE）：>30分钟进行分析。28名（13.0%）儿童存活至出院，但仅有17名（7.9%）具有良好的神经功能预后。共有41名（18.9%）儿童接受了EE；与IE和LE相比，这与复苏后期心动过速（73.9%）显著相关（P<0.05）。在校正混杂因素后，心动过速（比值比：7.41，95%置信区间：1.96 - 29.31）和高血压（比值比：6.03，95%置信区间：1.85 - 13.77）与EE显著相关。与中期和晚期相比，EE在总体预后方面也显著更好（任何ROSC、持续ROSC、存活至重症监护病房、入院、存活至出院及良好神经功能预后，均P<0.05）。EE有助于实现ROSC，但也与复苏后早期更多的心动过速和高血压相关。在非创伤性且非可电击心律的OHCA儿童中，与中期和晚期相比，EE与更高的生存率及更好的神经功能预后相关。
