Gueugniaud P Y, Mols P, Goldstein P, Pham E, Dubien P Y, Deweerdt C, Vergnion M, Petit P, Carli P
Department of Anesthesiology and Emergency Medical System, Edouard Herriot Hospital, Claude Bernard University, Lyons, France.
N Engl J Med. 1998 Nov 26;339(22):1595-601. doi: 10.1056/NEJM199811263392204.
Clinical trials have not shown a benefit of high doses of epinephrine in the management of cardiac arrest. We conducted a prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest.
Adult patients who had cardiac arrest outside the hospital were enrolled if the cardiac rhythm continued to be ventricular fibrillation despite the administration of external electrical shocks, or if they had asystole or pulseless electrical activity at the time epinephrine was administered. We randomly assigned 3327 patients to receive up to 15 high doses (5 mg each) or standard doses (1 mg each) of epinephrine according to the current protocol for advanced cardiac life support.
In the high-dose group, 40.4 percent of 1677 patients had a return of spontaneous circulation, as compared with 36.4 percent of 1650 patients in the standard-dose group (P=0.02); 26.5 percent of the patients in the high-dose group and 23.6 percent of those in the standard-dose group survived to be admitted to the hospital (P=0.05); 2.3 percent of the patients in the high-dose group and 2.8 percent in the standard-dose group survived to be discharged from the hospital (P=0.34). There was no significant difference in neurologic status according to treatment among those discharged. High-dose epinephrine improved the rate of successful resuscitation in patients with asystole, but not in those with ventricular fibrillation.
In our study, long-term survival after cardiac arrest outside the hospital was no better with repeated high doses of epinephrine than with repeated standard doses.
临床试验尚未表明高剂量肾上腺素在心脏骤停处理中具有益处。我们进行了一项前瞻性、多中心、随机研究，比较院外心脏骤停病例中重复高剂量肾上腺素与重复标准剂量肾上腺素的效果。
院外发生心脏骤停的成年患者，若在给予体外电击后心律仍为心室颤动，或在给予肾上腺素时出现心脏停搏或无脉电活动，则纳入研究。根据当前高级心脏生命支持方案，我们将3327例患者随机分组，分别接受高达15次高剂量（每次5毫克）或标准剂量（每次1毫克）的肾上腺素治疗。
在高剂量组的1677例患者中，40.4%恢复自主循环，而标准剂量组的1650例患者中这一比例为36.4%（P = 0.02）；高剂量组26.5%的患者存活至入院，标准剂量组为23.6%（P = 0.05）；高剂量组2.3%的患者存活至出院，标准剂量组为2.8%（P = 0.34）。出院患者中，根据治疗方法不同，神经功能状态无显著差异。高剂量肾上腺素提高了心脏停搏患者的成功复苏率，但对心室颤动患者无效。
在我们的研究中，院外心脏骤停后，重复高剂量肾上腺素治疗的长期生存率并不优于重复标准剂量治疗。
