Kubo Atsushi, Hiraide Atsushi, Shinozaki Tomohiro, Shibata Naoaki, Miyamoto Kyohei, Tamura Shinobu, Inoue Shigeaki
Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan.
Faculty of Emergency Medical Science, Meiji University of Integrative Medicine, Kyoto, Japan.
Sci Rep. 2025 Jan 2;15(1):274. doi: 10.1038/s41598-024-84950-8.
OHCA (out-of-hospital cardiac arrest) patients have improved neurological outcomes with public-access automated external defibrillator (PAD) use. However, the benefit of epinephrine administration after PAD use remains controversial. The purpose of the study was to investigate the impact of epinephrine administration on neurological outcomes in OHCA patients after PAD use. This study assessed 2,059,417 patients from the All-Japan Utstein Registry between 2005 and 2021. Patients were categorized into two groups: shockable and non-shockable rhythms on emergency medical service (EMS) arrival. Propensity score matching was used to adjust for various confounders and to analyze the impact of epinephrine administration on one-month favorable neurological outcomes. Criteria for bystander PAD was met by 11,629 (0.56%) of the enrolled patients. The mean age was 70 years with 71.9% male. Among them, 38.6% had shockable rhythms and 61.4% had non-shockable rhythms. After the matching, epinephrine administration negatively affected one-month favorable neurological outcome in patients with both shockable (14.7% vs. 41.1%, OR = 0.24, 95% CI = 0.19-0.31) and non-shockable rhythms (3.6% vs. 10.8%, OR = 0.31, 95% CI = 0.23-0.42). These findings suggest that epinephrine administration did not improve neurological outcomes in patients with OHCA after PAD use, providing insights to optimize EMS protocols for OHCA.
院外心脏骤停（OHCA）患者使用公众可及的自动体外除颤器（PAD）后神经功能预后得到改善。然而，使用PAD后给予肾上腺素的益处仍存在争议。本研究的目的是调查给予肾上腺素对OHCA患者使用PAD后神经功能预后的影响。本研究评估了2005年至2021年间全日本Utstein登记处的2059417例患者。患者被分为两组：紧急医疗服务（EMS）到达时可电击心律和不可电击心律。采用倾向评分匹配法调整各种混杂因素，并分析给予肾上腺素对1个月良好神经功能预后的影响。11629例（0.56%）入组患者符合旁观者PAD标准。平均年龄为70岁，男性占71.9%。其中，38.6%为可电击心律，61.4%为不可电击心律。匹配后，给予肾上腺素对可电击心律（14.7%对41.1%，OR = 0.24，95%CI = 0.19 - 0.31）和不可电击心律（3.6%对10.8%，OR = 0.31，95%CI = 0.23 - 0.42）的患者1个月良好神经功能预后均有负面影响。这些发现表明，OHCA患者使用PAD后给予肾上腺素并不能改善神经功能预后，为优化OHCA的EMS方案提供了见解。
