对难治性可电击心律的成年院外心脏骤停患者使用肾上腺素：基于全国人群登记的时间依赖性倾向评分序列匹配分析

Epinephrine administration for adult out-of-hospital cardiac arrest patients with refractory shockable rhythm: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry.

作者信息

Matsuyama Tasuku, Komukai Sho, Izawa Junichi, Gibo Koichiro, Okubo Masashi, Kiyohara Kosuke, Kiguchi Takeyuki, Iwami Taku, Ohta Bon, Kitamura Tetsuhisa

机构信息

Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.

出版信息

Eur Heart J Cardiovasc Pharmacother. 2022 May 5;8(3):263-271. doi: 10.1093/ehjcvp/pvab013.

DOI:10.1093/ehjcvp/pvab013

PMID:33599265

Abstract

AIMS

Little is known about the effect of prehospital epinephrine administration in out-of-hospital cardiac arrest (OHCA) patients with refractory shockable rhythm, for whom initial defibrillation was unsuccessful.

METHODS AND RESULTS

This study using Japanese nationwide population-based registry included all adult OHCA patients aged ≥18 years with refractory shockable rhythm between January 2014 and December 2017. Patients with or without epinephrine during cardiac arrest were sequentially matched using a risk set matching based on the time-dependent propensity scores within the same minute. The primary outcome was 1-month survival. The secondary outcomes included 1-month survival with favourable neurological outcome (cerebral performance category scale: 1 or 2) and prehospital return of spontaneous circulation (ROSC). Of the 499 944 patients registered in the database during the study period, 22 877 were included. Among them, 8467 (37.0%) received epinephrine. After time-dependent propensity score-sequential matching, 16 798 patients were included in the matched cohort. In the matched cohort, positive associations were observed between epinephrine and 1-month survival [epinephrine: 17.3% (1454/8399) vs. no epinephrine: 14.6% (1224/8399); RR 1.22 (95% confidence interval, CI: 1.13-1.32)] and prehospital ROSC [epinephrine: 22.2% (1868/8399) vs. no epinephrine: 10.7% (900/8399); RR 2.07 (95% CI: 1.91-2.25)]. No significant positive association was observed between epinephrine and favourable neurological outcome [epinephrine: 7.8% (654/8399) vs. no epinephrine: 7.1% (611/8399); RR 1.13 (95% CI 0.998-1.27)].

CONCLUSION

Using the nationwide population-based registry with time-dependent propensity score-sequential matching analysis, prehospital epinephrine administration in adult OHCA patients with refractory shockable rhythm was positively associated with 1-month survival and prehospital ROSC.

摘要

目的

对于院外心脏骤停（OHCA）且初始除颤未成功的难治性可电击心律患者，院前给予肾上腺素的效果鲜为人知。

方法与结果

本研究利用日本全国基于人群的登记系统，纳入了2014年1月至2017年12月期间所有年龄≥18岁的成年OHCA难治性可电击心律患者。根据同一分钟内的时间依赖性倾向得分，采用风险集匹配法对心脏骤停期间使用或未使用肾上腺素的患者进行序贯匹配。主要结局为1个月生存率。次要结局包括1个月时具有良好神经功能结局（脑功能分类量表：1或2）的生存率和院前自主循环恢复（ROSC）。在研究期间数据库中登记的499944例患者中，有22877例被纳入。其中，8467例（37.0%）接受了肾上腺素治疗。经过时间依赖性倾向得分序贯匹配后，16798例患者被纳入匹配队列。在匹配队列中，观察到肾上腺素与1个月生存率[肾上腺素：17.3%（1454/8399） vs. 未用肾上腺素：14.6%（1224/8399）；RR 1.22（95%置信区间，CI：1.13 - 1.32）]以及院前ROSC[肾上腺素：22.2%（1868/8399） vs. 未用肾上腺素：10.7%（900/8399）；RR 2.07（95%CI：1.91 - 2.25）]呈正相关。肾上腺素与良好神经功能结局之间未观察到显著正相关[肾上腺素：7.8%（654/8399） vs. 未用肾上腺素：7.1%（611/8399）；RR 1.13（95%CI 0.998 - 1.27）]。