Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2023 Oct 19;13(1):17836. doi: 10.1038/s41598-023-44991-x.
Survival benefits of prehospital advanced airway and epinephrine in out-of-hospital cardiac arrest (OHCA) patients are controversial, but few studies evaluated this together. This study evaluated association of prehospital advanced airway and epinephrine with survival outcomes in OHCA patients. This was observational study using a prospective multicentre KoCARC registry. Adult OHCA patients between October 2015 and December 2021 were included. The variables of interest were prehospital managements, which was classified into basic life support (BLS)-only, BLS + advanced airway, and BLS + advanced airway + epinephrine. In total, 8217 patients were included in analysis. Survival to discharge and good neurological outcomes were lowest in the BLS + advanced airway + epinephrine group (22.1% in BLS-only vs 13.2% in BLS + advanced airway vs 7.5% in BLS + advanced airway + epinephrine, P < 0.001 and 17.1% in BLS-only vs 9.2% in BLS + advanced airway vs 4.3% in BLS + advanced airway + epinephrine, P < 0.001, respectively). BLS + advanced airway + epinephrine group was less likely to survive to discharge and have good neurological outcomes (aOR 0.39, 95% CI 0.28-0.55, P < 0.001 and aOR 0.33, 95% CI 0.21-0.51, P < 0.001, respectively) than BLS-only group after adjusting for potential confounders. In prehospital settings with intermediate EMS providers and prehospital advanced airway insertion is performed followed by epinephrine administration, prehospital management with BLS + advanced airway + epinephrine in OHCA patients was associated with lower survival to discharge rate compared to BLS-only.
在院外心脏骤停（OHCA）患者中，院前高级气道和肾上腺素的生存获益存在争议，但很少有研究同时评估这两者。本研究评估了 OHCA 患者院前高级气道和肾上腺素与生存结果的关联。这是一项使用前瞻性多中心 KoCARC 登记处的观察性研究。纳入 2015 年 10 月至 2021 年 12 月期间的成年 OHCA 患者。感兴趣的变量是院前管理，分为基本生命支持（BLS）-仅、BLS+高级气道和 BLS+高级气道+肾上腺素。总共纳入 8217 例患者进行分析。仅 BLS 组的出院存活率和良好神经结局最低（BLS 仅为 22.1%，BLS+高级气道为 13.2%，BLS+高级气道+肾上腺素为 7.5%，P<0.001；BLS 仅为 17.1%，BLS+高级气道为 9.2%，BLS+高级气道+肾上腺素为 4.3%，P<0.001）。BLS+高级气道+肾上腺素组出院存活率和良好神经结局的可能性较低（调整潜在混杂因素后，aOR 分别为 0.39，95%CI 0.28-0.55，P<0.001 和 aOR 0.33，95%CI 0.21-0.51，P<0.001）。在中级 EMS 提供者和院前高级气道插入的院前环境中，在进行肾上腺素给药后，与仅 BLS 相比，OHCA 患者的 BLS+高级气道+肾上腺素院前管理与较低的出院存活率相关。
