Hubble Michael W, Taylor Stephen, Martin Melisa, Houston Sara, Kaplan Ginny R
Department of Emergency Medical Science, Wake Technical Community College, 2901 Holston Lane, Raleigh, NC, 27610, USA.
East Carolina University, Greenville, NC, USA.
Ir J Med Sci. 2024 Dec;193(6):2713-2721. doi: 10.1007/s11845-024-03797-0. Epub 2024 Aug 27.
Cardiac arrest patients presenting with non-shockable rhythms have a low probability of survival, and epinephrine is one of the few pharmaceutical options for this group. The recommended 1.0 mg adult dose is extrapolated from early animal studies and lacks adjustment for patient weight. Although several prior studies have investigated "low-" and "high-" dose epinephrine, none have identified a benefit to either strategy.
To identify an optimal weight-based epinephrine dose for return-of-spontaneous-circulation (ROSC) after a single bolus among patients with low likelihood of survival.
Included were adult patients who experienced a witnessed, non-traumatic out-of-hospital cardiac arrest prior to EMS arrival. Patients with shockable presenting rhythms or receiving bystander CPR were excluded. The AUROC was used to assess the predictive value of epinephrine dose (mg/kg) for ROSC following a single bolus. From the ROC curve, the optimal threshold dosage (OTD) was determined using the Youden Index. A logistic regression model calculated the adjusted odds ratio of OTD on ROSC.
A total of 2,463 patients met inclusion criteria, of which 190 (7.7%) attained ROSC after the first epinephrine administration. The dosage AUROC for ROSC was 0.603 (p < 0.01). As calculated by the Youden index, the OTD was 0.013 mg/kg. Patients receiving ≥ OTD were more likely to attain ROSC after a single epinephrine bolus (OR = 2.25,p < 0.001).
Among patients with a low likelihood of survival, the optimal dose of epinephrine for attaining ROSC with a single bolus of epinephrine was 0.013 mg/kg. These findings should inspire further investigation into optimal dosing strategies for epinephrine.
表现为不可电击心律的心脏骤停患者生存概率较低，肾上腺素是针对该群体为数不多的药物选择之一。推荐的成人剂量1.0毫克是从早期动物研究推断而来，且未根据患者体重进行调整。尽管此前有多项研究调查了“低剂量”和“高剂量”肾上腺素，但均未发现这两种策略有任何益处。
确定在生存可能性较低的患者中，单次推注肾上腺素后实现自主循环恢复（ROSC）的基于体重的最佳肾上腺素剂量。
纳入在急救医疗服务（EMS）到达之前发生目击、非创伤性院外心脏骤停的成年患者。排除表现为可电击心律或接受旁观者心肺复苏的患者。使用受试者工作特征曲线下面积（AUROC）评估单次推注肾上腺素后肾上腺素剂量（毫克/千克）对ROSC的预测价值。根据ROC曲线，使用约登指数确定最佳阈值剂量（OTD）。逻辑回归模型计算OTD对ROSC的调整优势比。
共有2463例患者符合纳入标准，其中190例（7.7%）在首次给予肾上腺素后实现ROSC。ROSC的剂量AUROC为0.603（p＜0.01）。根据约登指数计算，OTD为0.013毫克/千克。接受≥OTD的患者在单次推注肾上腺素后更有可能实现ROSC（OR = 2.25，p＜0.001）。
在生存可能性较低的患者中，单次推注肾上腺素实现ROSC的最佳肾上腺素剂量为0.013毫克/千克。这些发现应促使对肾上腺素的最佳给药策略进行进一步研究。
