Abstract
This study was to identify the effect of epinephrine on the survival of out-of-hospital cardiac arrest (OHCA) patients and changes in prehospital emergency medical services (EMSs) after the introduction of prehospital epinephrine use by EMS providers. This was a retrospective observational study comparing two groups (epinephrine group and norepinephrine group). We used propensity score matching of the two groups and identified the association between outcome variables regarding survival and epinephrine use, controlling for confounding factors. The epinephrine group was 339 patients of a total 1943 study population. The survival-to-discharge rate and OR (95% CI) of the epinephrine group were 5.0% (p = 0.215) and 0.72 (0.43–1.21) in the total patient population and 4.7% (p = 0.699) and 1.15 (0.55–2.43) in the 1:1 propensity-matched population. The epinephrine group received more mechanical chest compression and had longer EMS response times and scene times than the norepinephrine group. Mechanical chest compression was a negative prognostic factor for survival to discharge and favorable neurological outcomes in the epinephrine group. The introduction of prehospital epinephrine use in OHCA patients yielded no evidence of improvement in survival to discharge and favorable neurological outcomes and adversely affected the practice of EMS providers, exacerbating the factors negatively associated with survival from OHCA.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a serious public health concern
588 patients were excluded by exclusion criteria, and 59 patients were excluded by events that occurred in health care facility staffing with physicians
248 patients were excluded due to duplicated data, missing in-hospital data, refusal to provide hospital data and the absence of data on epinephrine
Summary
The survival rate for OHCA patients varies according to the emergency medical services (EMSs) in each country. The dramatic improvement of survival rate over the decades does not seem to have been significant [1,2]. There have been many prehospital efforts to increase the survival rate of OHCA patients, and current guidelines recommend epinephrine use for advanced life support (ALS) in OHCA [3,4]. A study in Singapore reported that the introduction of intravenous epinephrine to an EMS system did not yield a significant survival benefit [5]. A study in Japan reported that prehospital administration of epinephrine by an EMS is favorably associated with long-term neurological outcomes in patients with initial asystole [6]. A recent study by Perkins et al [7]
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