Abstract
BackgroundPrehospital resuscitation for patients with major trauma emphasizes a load-and-go principle. For traumatic cardiac arrest (TCA) patients, the administration of vasopressors remains under debate. This study evaluated the effectiveness of epinephrine in the prehospital setting for patients with TCA.MethodsWe conducted a retrospective cohort study using a prospectively collected registry for out-of-hospital cardiac arrest in Taipei. Enrollees were ≥18 years of age with TCA. Patients with signs of obvious death like decapitation or rigor mortis were excluded. Patients were grouped according to prehospital administration, or lack thereof, of epinephrine. Outcomes were sustained (≥2 h) recovery of spontaneous circulation (ROSC) and survival to discharge. A subgroup analysis was performed by stratified total prehospital time.ResultsFrom June 1 2010 to May 31 2013, 514 cases were enrolled. Epinephrine was administered in 43 (8.4 %) cases. Among all patients, sustained ROSC and survival to discharge was 101 (19.6 %) and 20 (3.9 %), respectively. The epinephrine group versus the non-epinephrine group had higher sustained ROSC (41.9 % vs. 17.6 %, p < 0.01) and survival to discharge (14.0 % vs. 3.0 %, p < 0.01). The adjusted odds ratios (ORs) of epinephrine effect were 2.24 (95 % confidence interval (CI) 1.05-4.81) on sustained ROSC, and 2.94 (95 % CI 0.85-10.15) on survival to discharge. Subgroup analysis showed increased ORs of epinephrine effect on sustained ROSC with a longer prehospital time.ConclusionAmong adult patients with TCA in an Asian metropolitan area, administration of epinephrine in the prehospital setting was associated with increased short-term survival, especially for those with a longer prehospital time.
Highlights
Prehospital resuscitation for patients with major trauma emphasizes a load-and-go principle
A previous study using an animal model with uncontrolled hemorrhagic shock linked the use of epinephrine to worse outcomes compared to high-volume fluid resuscitation [12], a recent report supported the use of vasopressors in “buying time” for definitive treatment for uncontrolled hemorrhagic shock in rats [13]
The service is provided by 45 ambulance teams staffed by 1020 emergency medical technicians (EMTs) who each completed at least 264 hours of training
Summary
Prehospital resuscitation for patients with major trauma emphasizes a load-and-go principle. For traumatic cardiac arrest (TCA) patients, the administration of vasopressors remains under debate. Among the advanced resuscitative strategies for TCA, the effect of epinephrine (adrenaline) on patient outcome is still under debate. Prehospital administration of epinephrine during cardiopulmonary resuscitation (CPR) in non-traumatic out-of-hospital cardiac arrest (OHCA) has been shown to induce improved return of spontaneous circulation (ROSC) ratio and short-term survival, but point towards either no benefit or even harm of this drug for long-term survival or functional recovery [9, 13,14,15,16,17,18,19]. A recent report in patients with non-shockable cardiac arrest in hospital, demonstrated that earlier administration of epinephrine was associated with a higher probability of ROSC, survival in hospital, and neurologically intact survival [20]
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