Hubble Michael W, Taylor Stephen, Martin Melisa, Houston Sara, Kaplan Ginny R, Kearns Randy D
Department of Emergency Medical Science, Wake Technical Community College, 2901 Holston Lane, Holston Lane, Raleigh, 27610, NC, USA.
East Carolina University, Greenville, NC, USA.
Ir J Med Sci. 2025 Jun 21. doi: 10.1007/s11845-025-03979-4.
Prolonged resuscitation is associated with poor patient outcomes. While the importance of bystander CPR and early defibrillation is well-known, the role of other components affecting resuscitation duration is less well-established. We postulated that first-dose intraosseous (IO) epinephrine would prolong the pressor-to-ROSC interval compared to intravenous (IV) drug administration.
To describe the relationship between first epinephrine administration route and pressor-to-ROSC intervals.
A retrospective analysis of the 2020 ESO Data Collaborative Annual Research dataset was conducted among adults who experienced non-traumatic, bystander-witnessed arrests. A Cox proportional hazard model was used to determine the influence of first epinephrine route on the pressor-to-ROSC interval. End-of-event was defined as ROSC, field termination of resuscitation, or hospital arrival without ROSC, with right censoring of the latter group.
Overall, 9351 patients were included for analysis, of which 63.9% were males. The mean age of participants was 65.3(± 15.5) years and presumed cardiac etiology was present in 82.7% of arrests. An initial shockable rhythm was present in 27.1%, while 29.7% received bystander CPR and 39.7% attained ROSC. The mean pressor-to-ROSC interval was 13.21(± 9.65), 14.86 (± 10.89), and 14.42 (± 10.52) minutes for the intravenous, tibial IO, and humeral IO routes, respectively (p < 0.001). First epinephrine administration via the tibial or humeral IO route was associated with a decreased hazard of ROSC compared to the IV route (HR = 0.78, p < 0.001 and HR = 0.86, p = 0.01 per minute, respectively).
These data suggest that the tibial and humeral IO routes of first epinephrine administration were associated with marginally prolonged resuscitation duration after drug administration and decreasing hazard of ROSC.
长时间复苏与患者不良预后相关。虽然旁观者心肺复苏术（CPR）和早期除颤的重要性已广为人知，但其他影响复苏持续时间的因素的作用尚不明确。我们推测，与静脉注射药物相比，首剂骨内（IO）肾上腺素会延长升压至恢复自主循环（ROSC）的间隔时间。
描述首剂肾上腺素给药途径与升压至ROSC间隔时间之间的关系。
对2020年欧洲复苏委员会（ESO）数据协作年度研究数据集进行回顾性分析，研究对象为经历非创伤性、有旁观者目击的心脏骤停的成年人。采用Cox比例风险模型来确定首剂肾上腺素给药途径对升压至ROSC间隔时间的影响。事件终点定义为恢复自主循环、现场终止复苏或未恢复自主循环而到达医院，后者进行右删失。
总体而言，9351例患者纳入分析，其中63.9%为男性。参与者的平均年龄为65.3（±15.5）岁，82.7%的心脏骤停患者推测病因是心脏方面的。27.1%的患者初始心律为可除颤心律，29.7%的患者接受了旁观者心肺复苏术，39.7%的患者恢复了自主循环。静脉注射、胫骨IO和肱骨IO途径的平均升压至ROSC间隔时间分别为13.21（±9.65）、14.86（±10.89）和14.42（±10.52）分钟（p<0.001）。与静脉注射途径相比，通过胫骨或肱骨IO途径给予首剂肾上腺素与恢复自主循环的风险降低相关（风险比分别为0.78，p<0.001和0.86，每分钟p = 0.01）。
这些数据表明，首剂肾上腺素通过胫骨和肱骨IO途径给药与给药后复苏持续时间略有延长以及恢复自主循环的风险降低相关。
