Abstract
BackgroundTo determine if the effects of epinephrine administration on the outcome of out-of-hospital cardiac arrest (OHCA), patients are associated with the duration of cardiopulmonary resuscitation (CPR) performed by Emergency Medical Service (EMS) personnel.MethodsThis retrospective, nonrandomized, observational analysis used the All-Japan Utstein Registry, a prospective, nationwide population-based registry of all OHCA patients transported to the hospital by EMS staff as the data source. We stratified all OHCA patients for quartile of EMSs’ CPR duration. Group 1 consisted of patients who fell under the 25th percentile of EMSs’ CPR duration (under 15 min); group 2, patients who fell into the 25th to 50th percentile (between 15 and 19 min); group 3, patients who fell into the 50th to 75th percentile (between 20 and 26 min); and group 4, patients who fell at or above the 75th percentile (over 26 min). The primary endpoint was a favorable neurological outcome 1 month after cardiac arrest. The secondary endpoints were ROSC before arrival at the hospital and 1-month survival.ResultsA total of 383,811 patients aged over 18 years who had experienced OHCA between 2006 and 2010 in Japan, when stratified for quartile of EMSs’ CPR duration, the epinephrine administration increased the rate of return of spontaneous circulation (ROSC) approximately tenfold in all groups. However, the beneficial effects of epinephrine administration on 1-month survival disappeared in patients on whom EMSs’ CPR had been performed for more than 26 min, and the beneficial effects of epinephrine administration on neurological outcomes were observed only in patients on whom EMSs’ CPR had been performed between 15 and 19 min (odds ratio, 1.327, 95 % confidence intervals, 1.017–1.733 P = 0.037).ConclusionsEpinephrine administration is associated with an increase of ROSC and with improvement in the neurological outcome on which EMSs’ CPR duration is performed between 15 and 19 min.
Highlights
To determine if the effects of epinephrine administration on the outcome of out-of-hospital cardiac arrest (OHCA), patients are associated with the duration of cardiopulmonary resuscitation (CPR) performed by Emergency Medical Service (EMS) personnel
In a recent large prospective observational propensity analysis of epinephrine administration to OHCA patients using the All-Japan Utstein database, Hagihara et al [9] concluded that prehospital epinephrine administration to patients with OHCA significantly increases the likelihood of return of spontaneous circulation (ROSC) before hospital arrival but is not associated with an increase in either survival or good functional outcome 1 month after the event
We excluded patients under 18 years of age; in whom spontaneous circulation had been restored before the arrival of EMS personnel; for whom medical records were missing data; whose condition had unlikely been due to cardiac arrest; for whom more than 480 min had elapsed from the emergency call to hospital arrival, more than 60 min from the emergency call to the initiation of CPR, or more than 120 min from the initiation of CPR to hospital; who had been transferred with a physician rather than with specially trained EMS personnel; and/or whose OHCA episode had been witnessed by EMS personnel
Summary
To determine if the effects of epinephrine administration on the outcome of out-of-hospital cardiac arrest (OHCA), patients are associated with the duration of cardiopulmonary resuscitation (CPR) performed by Emergency Medical Service (EMS) personnel. In a recent large prospective observational propensity analysis of epinephrine administration to OHCA patients using the All-Japan Utstein database, Hagihara et al [9] concluded that prehospital epinephrine administration to patients with OHCA significantly increases the likelihood of ROSC before hospital arrival but is not associated with an increase in either survival or good functional outcome 1 month after the event. In support of epinephrine treatment, we hypothesized that the poor results observed in previous studies reflect their lack of consideration of the duration of CPR performed by EMS staff before the patient’s arrival at the hospital. To test the hypothesis that the effects of epinephrine administration on patient prognosis depend on the duration of CPR performed by EMS personnel, we evaluated the effect of the performance of EMSs’ CPR of four durations on the neurological outcomes of OHCA patients
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