H Tanaka1, H Takyu2, R Sagisaka2, H Ueta2, Toru Shirakawa2, Tomoya Kinoshi3, Hiroyuki Takahashi3, Takashi Nakagawa4, Syuji Shimazaki2, M Ong Eng Hock5. 1. Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan. Electronic address: hidetana@kokushikn.ac.jp. 2. Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan. 3. Department of Sports Medicine, Kokushikan University, Tokyo 206-8515, Japan. 4. Center for disaster medicine, Aichi Medical University, Nagakute 480-1195, Japan. 5. Department of Emergency Medicine, Singapore General Hospital, Outram 169608, Singapore; Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, College Rd 169857, Singapore.
Abstract
OBJECTIVE: To evaluate the time-independent effect of the early administration of epinephrine (EPI) on favorable neurological outcome (as CPC [cerebral performance category] 1-2) at 1 month in patients with out-of-hospital cardiac arrest. MATERIALS AND METHODS: A total of 119 639 witnessed cardiac arrest patients from 2008 to 2012 were eligible for this nationwide, prospective, population-based observational study. Patients were divided into EPI group (n = 20 420) and non-EPI group (n = 99 219). To determine the time-dependent effects of EPI, EPI-administered patients were divided into 4 groups as follows: early EPI (5-18 min), intermediate EPI (19-23 min), late EPI (24-29 min), and very late EPI (30-62 min), respectively. Multiple logistic regression analyses and adjusted odds ratios (AORs) were determined for CPC 1-2 at 1 month (primary outcome) and field return of spontaneous circulation (as secondary outcome) among the groups. RESULTS: The EPI and non-EPI group had identical background, but EPI group shows higher incidence public access defibrillation and emergency medical technician defibrillation delivered than the non-EPI group. The differences were clinically negligible. Higher return of spontaneous circulation rate (18.0%) and lower CPC 1-2 (2.9%) shown in the EPI group than in the non-EPI group (9.4% and 5.2%). In the time dependent analysis, CPC 1 to 2 was greatest in the early EPI group (AOR, 2.49; 95% confidence interval [CI], 1.90-3.27), followed by the intermediate EPI group (AOR, 1.53; 95% CI, 1.14-2.05) then the late EPI group (AOR, 0.71; 95% CI, 0.47-1.08) as reference. CONCLUSION: Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.
OBJECTIVE: To evaluate the time-independent effect of the early administration of epinephrine (EPI) on favorable neurological outcome (as CPC [cerebral performance category] 1-2) at 1 month in patients with out-of-hospital cardiac arrest. MATERIALS AND METHODS: A total of 119 639 witnessed cardiac arrestpatients from 2008 to 2012 were eligible for this nationwide, prospective, population-based observational study. Patients were divided into EPI group (n = 20 420) and non-EPI group (n = 99 219). To determine the time-dependent effects of EPI, EPI-administered patients were divided into 4 groups as follows: early EPI (5-18 min), intermediate EPI (19-23 min), late EPI (24-29 min), and very late EPI (30-62 min), respectively. Multiple logistic regression analyses and adjusted odds ratios (AORs) were determined for CPC 1-2 at 1 month (primary outcome) and field return of spontaneous circulation (as secondary outcome) among the groups. RESULTS: The EPI and non-EPI group had identical background, but EPI group shows higher incidence public access defibrillation and emergency medical technician defibrillation delivered than the non-EPI group. The differences were clinically negligible. Higher return of spontaneous circulation rate (18.0%) and lower CPC 1-2 (2.9%) shown in the EPI group than in the non-EPI group (9.4% and 5.2%). In the time dependent analysis, CPC 1 to 2 was greatest in the early EPI group (AOR, 2.49; 95% confidence interval [CI], 1.90-3.27), followed by the intermediate EPI group (AOR, 1.53; 95% CI, 1.14-2.05) then the late EPI group (AOR, 0.71; 95% CI, 0.47-1.08) as reference. CONCLUSION: Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.
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
Authors: Constantine D Mavroudis; Tiffany S Ko; Ryan W Morgan; Lindsay E Volk; William P Landis; Benjamin Smood; Rui Xiao; Marco Hefti; Timothy W Boorady; Alexandra Marquez; Michael Karlsson; Daniel J Licht; Vinay M Nadkarni; Robert A Berg; Robert M Sutton; Todd J Kilbaugh Journal: Crit Care Date: 2020-09-29 Impact factor: 9.097