Sakamoto Kenta, Yasuda Hideto, Shinzato Yutaro, Kishihara Yuki, Amagasa Shunsuke, Kashiura Masahiro, Moriya Takashi
Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan.
Acad Emerg Med. 2025 Jun;32(6):659-667. doi: 10.1111/acem.15089. Epub 2025 Jan 11.
This study aimed to clarify the appropriate timing for epinephrine administration in adults with out-of-hospital cardiac arrest (OHCA), particularly those cases with nonshockable rhythms, by addressing resuscitation time bias.
We performed a retrospective observational study utilizing a multicenter OHCA registry involving 95 hospitals in Japan between June 2014 and December 2020. We included patients with OHCA and nonshockable rhythms who received epinephrine during resuscitation. The primary and secondary outcomes were favorable 30-day neurological status and survival, respectively. A favorable neurological outcome was defined as a cerebral performance category score of 1 or 2. The time from emergency medical service (EMS) personnel contact to epinephrine administration was categorized in 5-min intervals. We used the Fine-Gray regression to calculate the time-dependent propensity score in each group. After risk set matching, we employed a generalized estimating equation (GEE) to adjust for within-patient clustering.
A total of 36,756 patients were included in the analysis. When involving timing variables and GEE, epinephrine administration significantly affected favorable 30-day neurological status at 1-5 and 6-10 min, with risk ratios (RR; 95% confidence intervals [CIs]) of 9.36 (1.19-73.7) and 3.67 (1.89-7.14), respectively. Epinephrine administration significantly affected 30-day survival at 1-5, 6-10, 11-15, and 16-20 min, with RRs (95% CIs) of 2.33 (1.41-3.85), 2.09 (1.65-2.65), 1.64 (1.32-2.05), or 1.70 (1.29-2.25), respectively.
Epinephrine administration within 10 min of EMS personnel contact may be associated with favorable neurological outcomes in patients with OHCA and nonshockable rhythms.
本研究旨在通过解决复苏时间偏差问题，明确院外心脏骤停（OHCA）成人患者，尤其是非可电击心律患者使用肾上腺素的合适时机。
我们进行了一项回顾性观察研究，利用日本95家医院参与的多中心OHCA登记系统，纳入2014年6月至2020年12月期间复苏时接受肾上腺素治疗的OHCA且心律为非可电击心律的患者。主要和次要结局分别为30天良好神经功能状态和存活。良好神经功能结局定义为脑功能分类评分为1或2。从紧急医疗服务（EMS）人员接触到使用肾上腺素的时间按5分钟间隔进行分类。我们使用Fine-Gray回归计算每组的时间依赖性倾向得分。在风险集匹配后，我们采用广义估计方程（GEE）对患者内聚类进行调整。
共有36756例患者纳入分析。当纳入时间变量和GEE时，在1 - 5分钟和6 - 10分钟使用肾上腺素显著影响30天良好神经功能状态，风险比（RR；95%置信区间[CI]）分别为9.36（1.19 - 73.7）和3.67（1.89 - 7.14）。在1 - 5分钟、6 - 10分钟、11 - 15分钟和16 - 20分钟使用肾上腺素显著影响30天存活，RR（95% CI）分别为2.33（1.41 - 3.85）、2.09（1.65 - 2.65）、1.64（1.32 - 2.05）或1.70（1.29 - 2.25）。
EMS人员接触后10分钟内使用肾上腺素可能与OHCA且心律为非可电击心律患者的良好神经功能结局相关。
