Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore.
Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
JAMA Netw Open. 2023 Mar 1;6(3):e235187. doi: 10.1001/jamanetworkopen.2023.5187.
While epinephrine has been widely used in prehospital resuscitation for pediatric patients with out-of-hospital cardiac arrest (OHCA), the benefit and optimal timing of epinephrine administration have not been fully investigated.
To evaluate the association between epinephrine administration and patient outcomes and to ascertain whether the timing of epinephrine administration was associated with patient outcomes after pediatric OHCA.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included pediatric patients (<18 years) with OHCA treated by emergency medical services (EMS) from April 2011 to June 2015. Eligible patients were identified from the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective OHCA registry at 10 sites in the US and Canada. Data analysis was performed from May 2021 to January 2023.
The main exposures were prehospital intravenous or intraosseous epinephrine administration and the interval between arrival of an advanced life support (ALS)-capable EMS clinician (ALS arrival) and the first administration of epinephrine.
The primary outcome was survival to hospital discharge. Patients who received epinephrine at any given minute after ALS arrival were matched with patients who were at risk of receiving epinephrine within the same minute using time-dependent propensity scores calculated from patient demographics, arrest characteristics, and EMS interventions.
Of 1032 eligible individuals (median [IQR] age, 1 [0-10] years), 625 (60.6%) were male. 765 patients (74.1%) received epinephrine and 267 (25.9%) did not. The median (IQR) time interval between ALS arrival and epinephrine administration was 9 (6.2-12.1) minutes. In the propensity score-matched cohort (1432 patients), survival to hospital discharge was higher in the epinephrine group compared with the at-risk group (epinephrine: 45 of 716 [6.3%] vs at-risk: 29 of 716 [4.1%]; risk ratio, 2.09; 95% CI, 1.29-3.40). The timing of epinephrine administration was also not associated with survival to hospital discharge after ALS arrival (P for the interaction between epinephrine administration and time to matching = .34).
In this study of pediatric patients with OHCA in the US and Canada, epinephrine administration was associated with survival to hospital discharge, while timing of the administration was not associated with survival.
虽然肾上腺素已广泛用于院外心脏骤停（OHCA）儿科患者的院前复苏，但肾上腺素的使用益处和最佳时机尚未得到充分研究。
评估肾上腺素给药与患者结局之间的关系，并确定 OHCA 后肾上腺素给药时机是否与患者结局相关。
设计、地点和参与者：本队列研究纳入了 2011 年 4 月至 2015 年 6 月期间接受紧急医疗服务（EMS）治疗的儿科 OHCA 患者（<18 岁）。从美国和加拿大 10 个地点的复苏结果联盟流行病学登记处的前瞻性 OHCA 登记处中确定了符合条件的患者。数据分析于 2021 年 5 月至 2023 年 1 月进行。
主要暴露因素是院前静脉内或骨内肾上腺素给药以及高级生命支持（ALS）能力的 EMS 临床医生到达（ALS 到达）和首次肾上腺素给药之间的间隔。
主要结局是存活至出院。接受 ALS 到达后任何给定分钟内肾上腺素的患者与在同一分钟内有风险接受肾上腺素的患者相匹配，使用从患者人口统计学、骤停特征和 EMS 干预措施计算的时间依赖性倾向评分。
在 1032 名符合条件的个体中（中位数[IQR]年龄，1[0-10]岁），625 名（60.6%）为男性。765 名患者（74.1%）接受了肾上腺素治疗，267 名（25.9%）未接受。ALS 到达与肾上腺素给药之间的中位（IQR）时间间隔为 9（6.2-12.1）分钟。在倾向评分匹配队列（1432 名患者）中，肾上腺素组的存活至出院率高于风险组（肾上腺素组：716 名中的 45 名[6.3%]与风险组：716 名中的 29 名[4.1%]；风险比，2.09；95%CI，1.29-3.40）。在 ALS 到达后，肾上腺素给药的时间也与存活至出院无关（肾上腺素给药和匹配时间之间的交互作用 P 值 = .34）。
在这项美国和加拿大儿科 OHCA 患者的研究中，肾上腺素给药与存活至出院相关，而给药时间与存活无关。
