Park Song Yi, Lim Daesung, Kim Seong Chun, Ryu Ji Ho, Kim Yong Hwan, Choi Byungho, Kim Sun Hyu
Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan 48114, Korea.
Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea.
J Clin Med. 2021 Dec 30;11(1):190. doi: 10.3390/jcm11010190.
This study was to identify the effect of epinephrine on the survival of out-of-hospital cardiac arrest (OHCA) patients and changes in prehospital emergency medical services (EMSs) after the introduction of prehospital epinephrine use by EMS providers. This was a retrospective observational study comparing two groups (epinephrine group and norepinephrine group). We used propensity score matching of the two groups and identified the association between outcome variables regarding survival and epinephrine use, controlling for confounding factors. The epinephrine group was 339 patients of a total 1943 study population. The survival-to-discharge rate and OR (95% CI) of the epinephrine group were 5.0% ( = 0.215) and 0.72 (0.43-1.21) in the total patient population and 4.7% ( = 0.699) and 1.15 (0.55-2.43) in the 1:1 propensity-matched population. The epinephrine group received more mechanical chest compression and had longer EMS response times and scene times than the norepinephrine group. Mechanical chest compression was a negative prognostic factor for survival to discharge and favorable neurological outcomes in the epinephrine group. The introduction of prehospital epinephrine use in OHCA patients yielded no evidence of improvement in survival to discharge and favorable neurological outcomes and adversely affected the practice of EMS providers, exacerbating the factors negatively associated with survival from OHCA.
本研究旨在确定肾上腺素对院外心脏骤停（OHCA）患者生存率的影响，以及急救医疗服务（EMS）人员开始在院前使用肾上腺素后，院前急救医疗服务的变化。这是一项比较两组（肾上腺素组和去甲肾上腺素组）的回顾性观察研究。我们对两组进行倾向得分匹配，并确定了与生存相关的结局变量和肾上腺素使用之间的关联，同时控制混杂因素。肾上腺素组为1943名研究总人群中的339名患者。在总患者人群中，肾上腺素组的出院生存率和OR（95%CI）分别为5.0%（ = 0.215）和0.72（0.43 - 1.21）；在1:1倾向得分匹配人群中，分别为4.7%（ = 0.699）和1.15（0.55 - 2.43）。与去甲肾上腺素组相比，肾上腺素组接受了更多的机械胸外按压，且EMS响应时间和现场时间更长。在肾上腺素组中，机械胸外按压是出院生存和良好神经学结局的不良预后因素。在OHCA患者中引入院前肾上腺素使用，没有证据表明出院生存率和良好神经学结局有所改善，且对EMS人员的操作产生了不利影响，加剧了与OHCA生存负相关的因素。
