OBJECTIVES: This study aimed to investigate whether early epinephrine administration in out-of-hospital cardiopulmonary arrest (OHCA) patients was associated with improved outcomes and to address the selection bias inherent in observational studies (more severe cases are more likely to receive epinephrine). METHODS: This was a retrospective analysis of prospectively collected population-based data of adult bystander-witnessed OHCA patients from a nationwide Japanese registry between January 2007 and December 2008. To address selection bias, those who attained early return of spontaneous circulation (ROSC) without epinephrine administration were excluded, leaving 49,165 patients in the analysis. The outcomes were intact neurologic survival, defined as survival with cerebral performance category score 1 or 2, and any survival at 1 month or at discharge (whichever was earlier). The primary predictor was the time from the start of cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) to first epinephrine administration, with early epinephrine defined as within 10 minutes. RESULTS: Multivariate logistic regression analysis showed that cardiac origin OHCA patients who received early epinephrine (≤ 10 minutes) had significantly higher rates of intact neurologic survival (odds ratio [OR]=1.39, 95% confidence interval [CI]=1.08 to 1.78) and any survival (OR=1.73, 95% CI=1.46 to 2.04) than those who did not receive early epinephrine, after adjusting for potential confounders. Results for noncardiac OHCA patients were similar. CONCLUSIONS: Early epinephrine administration may be associated with higher rates of intact neurologic survival and any survival in adult bystander-witnessed OHCA patients. This article provides a potential method to address the selection bias inherent in observational studies that examine the effects of drug administration in OHCA patients.
OBJECTIVES: This study aimed to investigate whether early epinephrine administration in out-of-hospital cardiopulmonary arrest (OHCA) patients was associated with improved outcomes and to address the selection bias inherent in observational studies (more severe cases are more likely to receive epinephrine). METHODS: This was a retrospective analysis of prospectively collected population-based data of adult bystander-witnessed OHCA patients from a nationwide Japanese registry between January 2007 and December 2008. To address selection bias, those who attained early return of spontaneous circulation (ROSC) without epinephrine administration were excluded, leaving 49,165 patients in the analysis. The outcomes were intact neurologic survival, defined as survival with cerebral performance category score 1 or 2, and any survival at 1 month or at discharge (whichever was earlier). The primary predictor was the time from the start of cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) to first epinephrine administration, with early epinephrine defined as within 10 minutes. RESULTS: Multivariate logistic regression analysis showed that cardiac origin OHCA patients who received early epinephrine (≤ 10 minutes) had significantly higher rates of intact neurologic survival (odds ratio [OR]=1.39, 95% confidence interval [CI]=1.08 to 1.78) and any survival (OR=1.73, 95% CI=1.46 to 2.04) than those who did not receive early epinephrine, after adjusting for potential confounders. Results for noncardiac OHCA patients were similar. CONCLUSIONS: Early epinephrine administration may be associated with higher rates of intact neurologic survival and any survival in adult bystander-witnessed OHCA patients. This article provides a potential method to address the selection bias inherent in observational studies that examine the effects of drug administration in OHCA patients.
Authors: Siobhan P Brown; Henry Wang; Tom P Aufderheide; Christian Vaillancourt; Robert H Schmicker; Sheldon Cheskes; Ron Straight; Peter Kudenchuk; Laurie Morrison; M Riccardo Colella; Joseph Condle; George Gamez; David Hostler; Tami Kayea; Sally Ragsdale; Shannon Stephens; Graham Nichol Journal: Am Heart J Date: 2014-11-20 Impact factor: 4.749
Authors: Mohamad Hakam Tiba; Brendan M McCracken; Brandon C Cummings; Carmen I Colmenero; Chandler J Rygalski; Cindy H Hsu; Thomas H Sanderson; Brahmajee K Nallamothu; Robert W Neumar; Kevin R Ward Journal: Resuscitation Date: 2019-05-20 Impact factor: 5.262
Authors: Nan Zhang; Xiu-Xian Zang; Ning Dong; Fang Liu; Shao-Kun Wang; H E Yan; DA-Hai Xu; Xiao-Liang Liu; L I Pang Journal: Exp Ther Med Date: 2016-01-28 Impact factor: 2.447
Authors: Francis Kim; Charles Maynard; Cameron Dezfulian; Michael Sayre; Peter Kudenchuk; Thomas Rea; Deborah Sampson; Michele Olsufka; Susanne May; Graham Nichol Journal: JAMA Date: 2021-01-12 Impact factor: 157.335