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. 2013 Dec 4;1(1):12.
doi: 10.1186/2052-0492-1-12. eCollection 2013.

Effects of epinephrine administration in out-of-hospital cardiac arrest based on a propensity analysis

Mineji Hayakawa  1 , Satoshi Gando  1 , Hirotoshi Mizuno  2 , Yasufumi Asai  2 , Yasuo Shichinohe  3 , Isao Takahashi  4 , Hiroshi Makise  5
Affiliations

Effects of epinephrine administration in out-of-hospital cardiac arrest based on a propensity analysis

Mineji Hayakawa et al. J Intensive Care. .

Abstract

Background: Epinephrine administration has been advocated for cardiopulmonary resuscitation (CPR) for decades. Despite the fact that epinephrine administration during CPR is internationally accepted, the effects of the prehospital epinephrine administration still remain controversial. We investigated the effects of epinephrine administration on patients with out-of-hospital cardiac arrest based on a propensity analysis with regard to the 'CPR time'.

Methods: From April 1, 2007, to December 31, 2009, 633 out-of-hospital cardiac arrest patients with bystander witnesses were included in the present study. To rule out any survival bias, we used the propensity scores, which included CPR time. CPR time was defined as the time span from when the emergency medical technicians started CPR until either the return of spontaneous circulation or arrival at the hospital. After performing propensity score matching, the epinephrine and no-drug groups each included 141 patients. The primary study endpoint was a favorable neurological outcome at 30 days after cardiac arrest.

Results: After propensity score matching, the frequency of the return of spontaneous circulation before arrival at the hospital in the matched epinephrine group was higher than that in the matched no-drug group (27% vs. 13%, P = 0.002). However, the frequency of a favorable neurological state did not differ between the two groups. With regard to the frequency of a favorable neurological state in the patients, the adjusted odds ratio of the time span from cardiac arrest to the first epinephrine administration was 0.917 (95% confidence interval 0.850-0.988, P = 0.023) per minute.

Conclusions: In patients with witnessed out-of-hospital cardiac arrest, prehospital epinephrine administration was associated with increase of the return of spontaneous circulation before arrival at the hospital. Moreover, the early administration of epinephrine might improve the overall neurological outcome.

Keywords: Cardiac arrest; Epinephrine; Prehospital; Propensity analysis; Utstein.

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Figures

Figure 1
Figure 1
A flow chart showing the inclusions and exclusions from the study. Patients under 8 years of age were excluded from the present study because emergency medical technicians were not permitted to administer epinephrine to these patients.
Figure 2
Figure 2
Scatter diagram of propensity scores of conditional probability of receiving epinephrine outside of hospital. The left side of the diagram shows the propensity scores in the two groups before matching. The right side of the diagram shows the propensity scores in the two groups after matching.
Figure 3
Figure 3
Odds ratios of time span from cardiac arrest to first administration of epinephrine adjusted by CPR time. Early administration of epinephrine increased the frequency of a favorable neurological outcome at 30 days after cardiac arrest, although it did not improve the other outcomes. The values in the right side of the figure were the odds ratios (95% confidence interval) and P values. The odds ratio was associated with a 1-min increase. EMT, emergency medical technician; ROSC, return of spontaneous circulation.
See this image and copyright information in PMC

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References

    1. Hazinski MF, Nolan JP, Billi JE, Bottiger BW, Bossaert L, De Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O’Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D. Part 1: executive summary: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010;122(Suppl 2):250–275. doi: 10.1161/CIRCULATIONAHA.110.970897. - DOI - PubMed
    1. Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA. 2009;302:2222–2229. doi: 10.1001/jama.2009.1729. - DOI - PubMed
    1. Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, Nichol G, Cousineau D, Blackburn J, Munkley D, Luinstra-Toohey L, Campeau T, Dagnone E, Lyver M. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351:647–656. doi: 10.1056/NEJMoa040325. - DOI - PubMed
    1. Herlitz J, Ekstrom L, Wennerblom B, Axelsson A, Bang A, Holmberg S. Adrenaline in out-of-hospital ventricular fibrillation: does it make any difference? Resuscitation. 1995;29:195–201. doi: 10.1016/0300-9572(94)00851-6. - DOI - PubMed
    1. Ohshige K, Shimazaki S, Hirasawa H, Nakamura M, Kin H, Fujii C, Okuchi K, Yamamoto Y, Akashi K, Takeda J, Hanyuda T, Tochikubo O. Evaluation of out-of-hospital cardiopulmonary resuscitation with resuscitative drugs: a prospective comparative study in Japan. Resuscitation. 2005;66:53–61. doi: 10.1016/j.resuscitation.2004.10.019. - DOI - PubMed

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