Abstract
BackgroundThe beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, particularly in trauma victims. Although no significant improvement in neurological outcomes has been found among resuscitated patients using epinephrine, including trauma patients, the use of epinephrine is recommended in the Advanced Trauma Life Support protocol. Given that the use of vasopressors was reported to be associated with increased mortality in patients with massive bleeding, the undesirable effects of epinephrine during the resuscitation of traumatic OHCA should be elucidated. We hypothesised that resuscitation with epinephrine would increase mortality in patients with OHCA following trauma.MethodsThis study is a post-hoc analysis of a prospective, multicentre, observational study on patients with OHCA between January 2012 and March 2013. We included adult patients with traumatic OHCA who were aged ≥15 years and excluded those with missing survival data. Patient data were divided into epinephrine or no-epinephrine groups based on the use of epinephrine during resuscitation at the hospital. Propensity scores were developed to estimate the probability of being assigned to the epinephrine group using multivariate logistic regression analyses adjusted for known survival predictors. The primary outcome was survival 7 days after injury, which was compared among the two groups after propensity score matching.ResultsOf the 1125 adults with traumatic OHCA during the study period, 1030 patients were included in this study. Among them, 822 (79.8%) were resuscitated using epinephrine, and 1.1% (9/822) in the epinephrine group and 5.3% (11/208) in the no-epinephrine group survived 7 days after injury. The use of epinephrine was significantly associated with decreased 7-day survival (odds ratio = 0.20; 95% CI = 0.08–0.48; P < 0.01), and this result was confirmed by propensity score-matching analysis, in which 178 matched pairs were examined (adjusted odds ratio = 0.11; 95% CI = 0.01–0.85; P = 0.02).ConclusionsThe relationship between the use of epinephrine during resuscitation and decreased 7-day survival was found in patients with OHCA following trauma, and the propensity score-matched analyses validated the results. Resuscitation without epinephrine in traumatic OHCA should be further studied in a randomised controlled trial.
Highlights
Epinephrine, an active sympathomimetic hormone stimulating the alpha- and beta-adrenergic systems [1], has been considered a major component of advanced life support for out-of-hospital cardiac arrest (OHCA) [2,3,4,5]
Epinephrine use for patients with traumatic OHCA has been reported in some regions [14, 15], and has been recommended in the Advanced Trauma Life Support protocol [16], potential harm was suggested in trauma victims [17,18,19]
Given that there was no significant improvement in neurological outcomes among resuscitated trauma patients using epinephrine [20], potential harm from its use during cardiopulmonary resuscitation (CPR) should be considered in trauma victims
Summary
Epinephrine, an active sympathomimetic hormone stimulating the alpha- and beta-adrenergic systems [1], has been considered a major component of advanced life support for out-of-hospital cardiac arrest (OHCA) [2,3,4,5]. A randomised controlled trial involving more than 8000 patients with OHCA identified no significant differences in favourable neurologic outcomes between patients treated with and without epinephrine, whereas epinephrine use resulted in a higher survival rate at 30 days [10]. Epinephrine use for patients with traumatic OHCA has been reported in some regions [14, 15], and has been recommended in the Advanced Trauma Life Support protocol [16], potential harm was suggested in trauma victims [17,18,19]. The beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, in trauma victims. Given that the use of vasopressors was reported to be associated with increased mortality in patients with massive bleeding, the undesirable effects of epinephrine during the resuscitation of traumatic OHCA should be elucidated. We hypothesised that resuscitation with epinephrine would increase mortality in patients with OHCA following trauma
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
