Braham David, Adams Daniel W S, Johnson Richard
Central Australian Retrieval Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
Emerg Med Australas. 2025 Feb;37(1):e14496. doi: 10.1111/1742-6723.14496. Epub 2024 Sep 4.
'Dirty adrenaline' is the informal term used for a rapidly made peripheral dilute adrenaline infusion in the emergency treatment of shock, most commonly 1 mg adrenaline in 1 L 0.9% NaCl. It has long been part of the remote clinician's arsenal despite no supporting scientific literature. Remote clinics in Central Australia can be hours away from critical care support. The region's high prevalence of renal and cardiac disease means that access to early vasopressors and inotropes is a necessity for treating shock. To tackle this, remote clinicians often use 'dirty adrenaline'. We present a review of 'dirty adrenaline' use in this region.
Central Australian Retrieval Service's database was screened to identify cases in which a peripheral dilute adrenaline infusion was administered in a remote clinic prior to patient aeromedical retrieval. A retrospective chart review collected: patient demographics; clinical characteristics; infusion details; adverse events; hospital lengths of stay; and mortality outcomes.
Fifty-seven cases were identified. Median patient age was 50 (range: 2-96). Septic shock was the most common clinical indication (40/57). Median infusion duration was 155 min. Median systolic BP from commencement until retrieval increased from 75.5 to 91 mmHg. Survival to hospital discharge was 86% (49/57). No significant adverse events associated with 'dirty adrenaline' were recorded.
'Dirty adrenaline' is safe to administer and appears to considerably improve survival when used to treat fluid-resistant shock in remote nurse-led clinics guided by an off-site critical care physician.
“脏肾上腺素”是在休克急救中快速配制的外周稀释肾上腺素输注液的非正式术语，最常见的是1毫克肾上腺素加入1升0.9%氯化钠溶液中。尽管缺乏科学文献支持，但长期以来它一直是偏远地区临床医生的常用手段。澳大利亚中部的偏远诊所距离重症监护支持可能有几个小时的路程。该地区肾脏和心脏疾病的高发病率意味着对于休克治疗而言，尽早使用血管升压药和正性肌力药是必要的。为了解决这一问题，偏远地区的临床医生经常使用“脏肾上腺素”。我们对该地区使用“脏肾上腺素”的情况进行了综述。
对澳大利亚中部检索服务中心的数据库进行筛选，以确定在患者航空医疗转运前在偏远诊所进行外周稀释肾上腺素输注的病例。通过回顾性病历审查收集：患者人口统计学资料；临床特征；输注细节；不良事件；住院时间；以及死亡率结果。
共确定了57例病例。患者中位年龄为50岁（范围：2 - 96岁）。感染性休克是最常见的临床指征（40/57）。中位输注持续时间为155分钟。从开始输注到转运期间，收缩压中位数从75.5毫米汞柱升至91毫米汞柱。出院生存率为86%（49/57）。未记录到与“脏肾上腺素”相关的显著不良事件。
在由异地重症监护医生指导的偏远地区护士主导的诊所中，当用于治疗对液体治疗无反应的休克时，“脏肾上腺素”给药安全，且似乎能显著提高生存率。
