Gordon A Ewy1, Bentley J Bobrow2, Vatsal Chikani3, Arthur B Sanders4, Charles W Otto5, Daniel W Spaite6, Karl B Kern7. 1. Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States. Electronic address: gaewy1933@gmail.com. 2. Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States; Bureau of EMS and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States. 3. Bureau of EMS and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States. 4. Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States. 5. Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Anesthesiology, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, AZ, United States. 6. Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States. 7. Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States.
Abstract
BACKGROUND: Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial. PURPOSE: To investigate the possible time-dependent outcomes associated with adrenaline administration by Emergency Medical Services personnel (EMS). METHODS: A retrospective analysis of prospectively collected data from a near statewide cardiac resuscitation database between 1 January 2005 and 30 November 2013. Multivariable logistic regression was used to analyze the effect of the time interval between EMS dispatch and the initial dose of adrenaline on survival. The primary endpoints were survival to hospital discharge and favourable neurologic outcome. RESULTS: Data from 3469 patients with witnessed OHCA were analyzed. Their mean age was 66.3 years and 69% were male. An initially shockable rhythm was present in 41.8% of patients. Based on a multivariable logistic regression model with initial adrenaline administration time interval (AATI) from EMS dispatch as the covariate, survival was greatest when adrenaline was administered very early but decreased rapidly with increasing (AATI); odds ratio 0.94 (95% Confidence Interval (CI) 0.92-0.97). The AATI had no significant effect on good neurological outcome (OR=0.96, 95% CI=0.90-1.02). CONCLUSIONS: In patients with OHCA, survival to hospital discharge was greater in those treated early with adrenaline by EMS especially in the subset of patients with a shockable rhythm. However survival rapidly decreased with increasing adrenaline administration time intervals (AATI).
BACKGROUND: Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial. PURPOSE: To investigate the possible time-dependent outcomes associated with adrenaline administration by Emergency Medical Services personnel (EMS). METHODS: A retrospective analysis of prospectively collected data from a near statewide cardiac resuscitation database between 1 January 2005 and 30 November 2013. Multivariable logistic regression was used to analyze the effect of the time interval between EMS dispatch and the initial dose of adrenaline on survival. The primary endpoints were survival to hospital discharge and favourable neurologic outcome. RESULTS: Data from 3469 patients with witnessed OHCA were analyzed. Their mean age was 66.3 years and 69% were male. An initially shockable rhythm was present in 41.8% of patients. Based on a multivariable logistic regression model with initial adrenaline administration time interval (AATI) from EMS dispatch as the covariate, survival was greatest when adrenaline was administered very early but decreased rapidly with increasing (AATI); odds ratio 0.94 (95% Confidence Interval (CI) 0.92-0.97). The AATI had no significant effect on good neurological outcome (OR=0.96, 95% CI=0.90-1.02). CONCLUSIONS: In patients with OHCA, survival to hospital discharge was greater in those treated early with adrenaline by EMS especially in the subset of patients with a shockable rhythm. However survival rapidly decreased with increasing adrenaline administration time intervals (AATI).
Authors: Matthew Hansen; Robert H Schmicker; Craig D Newgard; Brian Grunau; Frank Scheuermeyer; Sheldon Cheskes; Veer Vithalani; Fuad Alnaji; Thomas Rea; Ahamed H Idris; Heather Herren; Jamie Hutchison; Mike Austin; Debra Egan; Mohamud Daya Journal: Circulation Date: 2018-03-06 Impact factor: 29.690
Authors: Jacek Smereka; Lukasz Szarpak; Krzysztof J Filipiak; Milosz Jaguszewski; Jerzy R Ladny Journal: Resuscitation Date: 2020-04-15 Impact factor: 5.262
Authors: Gavin D Perkins; Claire Kenna; Chen Ji; Charles D Deakin; Jerry P Nolan; Tom Quinn; Charlotte Scomparin; Rachael Fothergill; Imogen Gunson; Helen Pocock; Nigel Rees; Lyndsey O'Shea; Judith Finn; Simon Gates; Ranjit Lall Journal: Intensive Care Med Date: 2020-01-07 Impact factor: 17.440