一种基于时间的倾向评分匹配方法，用于评估院外心脏骤停护理中肾上腺素对患者生存的影响。

A Time-Dependent Propensity Score Matching Approach to Assess Epinephrine Use on Patients Survival Within Out-of-Hospital Cardiac Arrest Care.

机构信息

Université de Lille, Centre Hospitalier Universitaire de Lille, METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France.

Emergency Department, University Hospital of Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; INSERM, Clinical Investigation Center, Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France.

出版信息

J Emerg Med. 2020 Oct;59(4):542-552. doi: 10.1016/j.jemermed.2020.06.016. Epub 2020 Jul 29.

DOI:10.1016/j.jemermed.2020.06.016

PMID:32739129

Abstract

BACKGROUND

Epinephrine effectiveness and safety are still questioned. It is well known that the effect of epinephrine varies depending on patients' rhythm and time to injection.

OBJECTIVE

We aimed to assess the association between epinephrine use during out-of-hospital cardiac arrest (OHCA) care and patient 30-day (D30) survival.

METHODS

Between 2011 and 2017, 27,008 OHCA patients were included from the French OHCA registry. We adjusted populations using a time-dependent propensity score matching. Analyses were stratified according to patient's first rhythm. After matching, 2837 pairs of patients with a shockable rhythm were created and 20,950 with a nonshockable rhythm.

RESULTS

Whatever the patient's rhythm (shockable or nonshockable), epinephrine use was associated with less D30 survival (odds ratio [OR] 0.508; 95% confidence interval [CI] 0.440-0.586] and OR 0.645; 95% CI 0.549-0.759, respectively). In shockable rhythms, on all outcomes, epinephrine use was deleterious. In nonshockable rhythms, no difference was observed regarding return of spontaneous circulation and survival at hospital admission. However, epinephrine use was associated with worse neurological prognosis (OR 0.646; 95% CI 0.549-0.759).

CONCLUSIONS

In shockable and nonshockable rhythms, epinephrine does not seem to have any benefit on D30 survival. These results underscore the need to perform further studies to define the optimal conditions for using epinephrine in patients with OHCA.

摘要

背景

肾上腺素的有效性和安全性仍存在争议。众所周知，肾上腺素的作用因患者的节律和注射时间而异。

目的

我们旨在评估在院外心脏骤停（OHCA）治疗期间使用肾上腺素与患者 30 天（D30）生存率之间的关系。

方法

在 2011 年至 2017 年期间，从法国 OHCA 登记处纳入了 27008 例 OHCA 患者。我们使用时间依赖性倾向评分匹配来调整人群。分析根据患者的初始节律进行分层。匹配后，创建了 2837 对可电击节律的患者和 20950 对非可电击节律的患者。

结果

无论患者的节律（可电击或非可电击）如何，使用肾上腺素均与 D30 生存率降低相关（优势比[OR] 0.508；95%置信区间[CI] 0.440-0.586 和 OR 0.645；95%CI 0.549-0.759）。在可电击节律中，在所有结局上，肾上腺素的使用均有害。在非可电击节律中，肾上腺素的使用与自主循环恢复和入院时存活无差异。然而，肾上腺素的使用与更差的神经预后相关（OR 0.646；95%CI 0.549-0.759）。