心搏骤停时冠状动脉内与静脉内肾上腺素的疗效比较。

Outcomes with intracoronary vs. intravenous epinephrine in cardiac arrest.

机构信息

College of Medicine, Department of Cardiology, Misr University for Science and Technology, Cairo, Egypt.

Department of Internal Medicine, Division of Cardiology, Ain Shams University, Cairo, Egypt.

出版信息

Eur Heart J Qual Care Clin Outcomes. 2024 Jan 12;10(1):99-103. doi: 10.1093/ehjqcco/qcad013.

DOI:10.1093/ehjqcco/qcad013

PMID:36792065

Abstract

BACKGROUND

Advanced Cardiovascular Life Support (ACLS) guidelines recommend intravenous (IV) and intraosseous (IO) epinephrine as a basic cornerstone in the resuscitation process. Data about the efficacy and safety of intracoronary (IC) epinephrine during cardiac arrest in the catheterization laboratory are lacking.

OBJECTIVE

To examine the efficacy and safety of IC vs. IV epinephrine for resuscitation during cardiac arrest in the catheterization laboratory.

METHODS AND RESULTS

This is a prospective observational study that included all patients who experienced cardiac arrest in the cath lab at two tertiary centres in Egypt from January 2015 to July 2022. Patients were divided into two groups according to the route of epinephrine given; IC vs. IV. The primary outcome was survival to hospital discharge. Secondary outcomes included rate of return of spontaneous circulation (ROSC), time-to-ROSC, and favourable neurological outcome at discharge defined as modified Rankin Scale (MRS) <3. A total of 162 patients met our inclusion criteria, mean age (60.69 ± 9.61), 34.6% women. Of them, 52 patients received IC epinephrine, and 110 patients received IV epinephrine as part of the resuscitation. Survival to hospital discharge was significantly higher in the IC epinephrine group (84.62% vs. 53.64%, P < 0.001) compared with the IV epinephrine group. The rate of ROSC was higher in the IC epinephrine group (94.23% vs. 70%, P < 0.001) and achieved in a shorter time (2.6 ± 1.97 min vs. 6.8 ± 2.11 min, P < 0.0001) compared with the IV group. Similarly, favourable neurological outcomes were more common in the IC epinephrine group (76.92% vs. 47.27%, P < 0.001) compared with the IV epinephrine group.

CONCLUSION

In this observational study, IC epinephrine during cardiac arrest in the cath lab appeared to be safe and may be associated with improved outcomes compared with the IV route. Larger randomized studies are encouraged to confirm these results.

摘要

背景

高级心血管生命支持（ACLS）指南推荐静脉内（IV）和骨内（IO）肾上腺素作为复苏过程中的基本基石。在导管实验室进行心脏骤停期间，关于冠状动脉内（IC）肾上腺素的疗效和安全性的数据尚缺乏。

目的

研究在导管实验室进行心脏骤停时，IC 与 IV 肾上腺素在复苏中的疗效和安全性。

方法和结果

这是一项前瞻性观察性研究，纳入了 2015 年 1 月至 2022 年 7 月在埃及两个三级中心导管实验室发生心脏骤停的所有患者。根据给予肾上腺素的途径，患者分为两组：IC 与 IV。主要结局是存活至出院。次要结局包括自主循环恢复（ROSC）率、ROSC 时间和出院时的良好神经功能结局（定义为改良 Rankin 量表（MRS）<3）。共有 162 名患者符合我们的纳入标准，平均年龄（60.69±9.61），34.6%为女性。其中，52 名患者接受 IC 肾上腺素治疗，110 名患者接受 IV 肾上腺素作为复苏的一部分。与 IV 肾上腺素组相比，IC 肾上腺素组存活至出院的比例显著更高（84.62%比 53.64%，P<0.001）。IC 肾上腺素组 ROSC 率更高（94.23%比 70%，P<0.001），达到 ROSC 的时间更短（2.6±1.97 分钟比 6.8±2.11 分钟，P<0.0001）。同样，IC 肾上腺素组的良好神经功能结局更为常见（76.92%比 47.27%，P<0.001）。