Abstract 345: The Effects of Epinephrine on the Outcomes of Patients With Out-of-Hospital Cardiac Arrest Based on a Propensity Analysis: A Nationwide Observational Study

Abstract

Background: Although prehospital epinephrine is frequently used in patients with out-of-hospital cardiac arrest (OHCA), its evidence is unclear. Recent studies have shown that the use of prehospital epinephrine increased the rate of return of spontaneous circulation but has a negative impact on outcomes. The aim of this study was to investigate the effect of prehospital epinephrine on the outcomes of OHCA. Methods: This study was a cross-sectional study using nationwide OHCA registry in Korea from 2015 to 2016. All EMS-treated adults OHCAs with presumed cardiac etiology were included. Patients who were witnessed by EMS provider were excluded. The primary outcome was neurologically favorable survival to discharge. We compared the primary outcomes between the prehospital epinephrine group and non-prehospital epinephrine group using a propensity score matching analysis and a multivariable logistic regression. Results: Among 58922 patients with OHCA, 37635 were included in the analysis. There were 3256 patients who received prehospital epinephrine. In the propensity score matching analysis, 3239 patients were enrolled in each group. Survival to discharge and good neurologic recovery were 5.0% and 2.5% in prehospital epinephrine group and 9.4% and 5.9% in non-prehospital epinephrine group (all p-value<o.o1). There was significant difference in good neurologic recovery between prehospital epinephrine group and non-prehospital epinephrine group after adjusting for covariates (adjusted OR, 0.38, 95% CI, 0.28-0.51). Similar results were observed for survival to discharge (adjusted OR, 0.47, 95% CI, 0.38-0.58). Conclusions: In Korean patients with OHCA, prehospital epinephrine increased the probability of ROSC, but decreased good neurologic recovery and survival to discharge.