Bomba Jared J, Benson Jamie, Hosmer David, Wolfson Daniel
Department of Surgery Larner College of Medicine at the University of Vermont Burlington Vermont USA.
Department of Radiology Larner College of Medicine at the University of Vermont Burlington Vermont USA.
J Am Coll Emerg Physicians Open. 2021 Oct 13;2(5):e12521. doi: 10.1002/emp2.12521. eCollection 2021 Oct.
Epinephrine in out-of-hospital cardiac arrest (OHCA) remains controversial and understudied in rural emergency medical services (EMS) systems. We evaluated the effects of allowing advanced emergency medical technicians (AEMTs) to administer epinephrine during OHCA in a rural EMS system.
An interrupted time series study was conducted using statewide EMS electronic records. Patients with OHCA before (phase I) and after (phase II) a protocol change expanding the AEMT scope of practice to include epinephrine for OHCA were identified. Number and timing of initial epinephrine administration, return of spontaneous circulation, and 30-day survival rates were compared using descriptive statistics, logistic regression, regression discontinuity, and propensity score matching.
A total of 1037 OHCAs met the inclusion criteria. In phase 1 compared with phase 2, 275 (56.12%) patients received epinephrine versus 624 (83.53%; < 0.001). The mean time to first administration of epinephrine for unwitnessed and bystander-witnessed OHCA were 11.73 minutes versus 8.17 minutes ( < 0.001) and 11.59 minutes versus 8.85 minutes ( < 0.01), respectively. Unadjusted analysis showed a decrease in 30-day survival rates among patients receiving epinephrine from 18.01% to 12.66% ( < 0.05). Adjusted analysis showed an increase in 30-day survival with decreased time to first epinephrine dose(OR 0.960, 1.005; 95% confidence interval, 0.929, 0.992).
Adding epinephrine for OHCA to the AEMT scope of practice was associated with an increased percentage of patients receiving epinephrine and decreased time to first administration of epinephrine for patients with unwitnessed OHCA. Unadjusted analysis showed a decrease in 30-day survival rates among patients receiving epinephrine. Adjusted analysis found that earlier administrationof epinephrine was associated with increased ROSC and 30-day survival.
在院外心脏骤停（OHCA）中使用肾上腺素仍存在争议，且在农村紧急医疗服务（EMS）系统中研究较少。我们评估了在农村EMS系统中允许高级急救医疗技术人员（AEMT）在OHCA期间使用肾上腺素的效果。
使用全州EMS电子记录进行中断时间序列研究。确定了在协议变更之前（第一阶段）和之后（第二阶段）发生OHCA的患者，该协议变更扩大了AEMT的执业范围，使其包括在OHCA中使用肾上腺素。使用描述性统计、逻辑回归、回归间断点分析和倾向得分匹配比较首次使用肾上腺素的次数和时间、自主循环恢复情况以及30天生存率。
共有1037例OHCA符合纳入标准。与第二阶段相比，第一阶段有275例（56.12%）患者接受了肾上腺素治疗，而第二阶段有624例（83.53%；P<0.001）。未被目击和有旁观者目击的OHCA患者首次使用肾上腺素的平均时间分别为11.73分钟对8.17分钟（P<0.001）和11.59分钟对8.85分钟（P<0.01）。未经调整的分析显示，接受肾上腺素治疗的患者30天生存率从18.01%降至12.66%（P<0.05）。调整后的分析显示，首次使用肾上腺素的时间缩短，30天生存率增加（比值比0.960，1.005；95%置信区间，0.929，0.992）。
将OHCA使用肾上腺素纳入AEMT的执业范围，与接受肾上腺素治疗的患者比例增加以及未被目击的OHCA患者首次使用肾上腺素的时间缩短有关。未经调整的分析显示，接受肾上腺素治疗的患者30天生存率降低。调整后的分析发现，更早使用肾上腺素与自主循环恢复和30天生存率增加有关。
