George Tyler S, Ashburn Nicklaus P, Snavely Anna C, Beaver Bryan P, Chado Michael A, Cannon Harris, Costa Casey G, Winslow James E, Nelson R Darrell, Stopyra Jason P, Mahler Simon A
Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Prehosp Emerg Care. 2025;29(1):37-45. doi: 10.1080/10903127.2024.2348663. Epub 2024 May 21.
A single dose epinephrine protocol (SDEP) for out-of-hospital cardiac arrest (OHCA) achieves similar survival to hospital discharge (SHD) rates as a multidose epinephrine protocol (MDEP). However, it is unknown if a SDEP improves SHD rates among patients with a shockable rhythm or those receiving bystander cardiopulmonary resuscitation (CPR).
This pre-post study, spanning 11/01/2016-10/29/2019 at 5 North Carolina EMS systems, compared pre-implementation MDEP and post-implementation SDEP in patients ≥18 years old with non-traumatic OHCA. Data on initial rhythm type, performance of bystander CPR, and the primary outcome of SHD were sourced from the Cardiac Arrest Registry to Enhance Survival. We compared SDEP vs MDEP performance in each rhythm (shockable and non-shockable) and CPR (bystander CPR or no bystander CPR) subgroup using Generalized Estimating Equations to account for clustering among EMS systems and to adjust for age, sex, race, witnessed arrest, arrest location, AED availability, EMS response interval, and presence of a shockable rhythm or receiving bystander CPR. The interaction of SDEP implementation with rhythm type and bystander CPR was evaluated.
Of 1690 patients accrued (899 MDEP, 791 SDEP), 19.2% (324/1690) had shockable rhythms and 38.9% (658/1690) received bystander CPR. After adjusting for confounders, SHD was increased after SDEP implementation among patients with bystander CPR (aOR 1.61, 95%CI 1.03-2.53). However, SHD was similar in the SDEP cohort vs MDEP cohort among patients without bystander CPR (aOR 0.81, 95%CI 0.60-1.09), with a shockable rhythm (aOR 0.96, 95%CI 0.48-1.91), and with a non-shockable rhythm (aOR 1.26, 95%CI 0.89-1.77). In the adjusted model, the interaction between SDEP implementation and bystander CPR was significant for SHD ( = 0.002).
Adjusting for confounders, the SDEP increased SHD in patients who received bystander CPR and there was a significant interaction between SDEP and bystander CPR. Single dose epinephrine protocol and MDEP had similar SHD rates regardless of rhythm type.
院外心脏骤停（OHCA）的单剂量肾上腺素方案（SDEP）与多剂量肾上腺素方案（MDEP）相比，实现了相似的出院生存率（SHD）。然而，尚不清楚SDEP是否能提高可电击心律患者或接受旁观者心肺复苏（CPR）患者的SHD率。
这项前后对照研究于2016年11月1日至2019年10月29日在北卡罗来纳州的5个急救医疗服务（EMS）系统中进行，比较了≥18岁非创伤性OHCA患者实施SDEP前后的MDEP情况。初始心律类型、旁观者CPR实施情况以及SHD的主要结局数据来自心脏骤停登记以提高生存率。我们使用广义估计方程比较了每个心律（可电击和不可电击）和CPR（旁观者CPR或无旁观者CPR）亚组中SDEP与MDEP的表现，以考虑EMS系统之间的聚类情况，并对年龄、性别、种族、目击骤停、骤停地点、自动体外除颤器（AED）可用性、EMS反应间隔以及是否存在可电击心律或接受旁观者CPR进行调整。评估了SDEP实施与心律类型和旁观者CPR之间的相互作用。
在纳入的1690例患者中（899例MDEP，791例SDEP），19.2%（324/1690）有可电击心律，38.9%（658/1690）接受了旁观者CPR。在调整混杂因素后，实施SDEP后接受旁观者CPR的患者的SHD增加（调整后比值比[aOR]1.61，95%置信区间[CI]1.03 - 2.53）。然而，在没有旁观者CPR的患者中，SDEP队列与MDEP队列的SHD相似（aOR 0.81，95%CI 0.60 - 1.09），有可电击心律的患者中相似（aOR 0.96，95%CI 0.48 - 1.91），有不可电击心律的患者中也相似（aOR 1.26，95%CI 0.89 - 1.77）。在调整模型中，SDEP实施与旁观者CPR之间的相互作用对SHD具有显著意义（P = 0.002）。
调整混杂因素后，SDEP提高了接受旁观者CPR患者的SHD，且SDEP与旁观者CPR之间存在显著相互作用。无论心律类型如何，单剂量肾上腺素方案和MDEP的SHD率相似。
