Behringer W, Kittler H, Sterz F, Domanovits H, Schoerkhuber W, Holzer M, Müllner M, Laggner A N
University of Vienna Medical School, Austria.
Ann Intern Med. 1998 Sep 15;129(6):450-6. doi: 10.7326/0003-4819-129-6-199809150-00004.
Epinephrine is the drug of choice in advanced cardiac life support, but it can have deleterious side effects after restoration of spontaneous circulation.
To investigate the association between the cumulative epinephrine dose used in advanced cardiac life support and neurologic outcome after cardiac arrest.
Retrospective cohort study.
University hospital.
Adults admitted to the emergency department with witnessed, nontraumatic, normothermic ventricular fibrillation cardiac arrest and unsuccessful initial defibrillation.
Functional neurologic outcome was regularly assessed by cerebral performance category (CPC) within 6 months after cardiac arrest. A CPC of 1 or 2 was defined as favorable recovery.
Among 178 enrolled patients, the median cumulative epinephrine dose administered was 4 mg (range, 0 to 50 mg). In 151 patients (84%), spontaneous circulation was restored; 63 of these 151 patients (42%) had favorable neurologic recovery. Patients with an unfavorable CPC received a significantly higher cumulative dose of epinephrine than did patients with a favorable CPC (4 mg compared with 1 mg; P < 0.001). This finding persisted after stratification by duration of resuscitation. After possible cofounders were controlled for, the cumulative epinephrine dose remained an independent predictor of unfavorable neurologic outcome.
The results indicate that an increasing cumulative dose of epinephrine administered during resuscitation is independently associated with unfavorable neurologic outcome after ventricular fibrillation cardiac arrest.
肾上腺素是高级心脏生命支持中的首选药物，但在自主循环恢复后可能会产生有害副作用。
探讨高级心脏生命支持中使用的肾上腺素累积剂量与心脏骤停后神经功能结局之间的关联。
回顾性队列研究。
大学医院。
因目击的、非创伤性、体温正常的室颤心脏骤停且初始除颤未成功而入住急诊科的成年人。
在心脏骤停后6个月内，通过脑功能分类（CPC）定期评估神经功能结局。CPC为1或2被定义为良好恢复。
在178例入组患者中，肾上腺素的中位累积给药剂量为4mg（范围为0至50mg）。151例患者（84%）恢复了自主循环；这151例患者中有63例（42%）神经功能恢复良好。CPC不良的患者接受的肾上腺素累积剂量明显高于CPC良好的患者（4mg对1mg；P<0.001）。这一发现经过复苏持续时间分层后仍然存在。在对可能的混杂因素进行控制后，肾上腺素累积剂量仍然是神经功能不良结局的独立预测因素。
结果表明，复苏期间肾上腺素累积剂量增加与室颤心脏骤停后神经功能不良结局独立相关。
