Yosuke Homma1, Takashi Shiga2, Hiraku Funakoshi3, Dai Miyazaki4, Atsushi Sakurai5, Yoshio Tahara6, Ken Nagao7, Naohiro Yonemoto8, Arino Yaguchi9, Naoto Morimura10. 1. Department of Emergency Medicine and Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan. Electronic address: yousukeh@jadecom.jp. 2. Department of Emergency Medicine and Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; Department of Emergency Medicine, International University of Health and Welfare, Tokyo, Japan. 3. Department of Emergency Medicine and Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. 4. Advanced Emergency Medical and Critical Care Center, Japanese Redcross Maebashi Hospital, Gunma, Japan. 5. Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan. 6. Department of Cardiovascular Medicine, National Cerebral and Cardio-vascular Center Hospital, Suita, Osaka, Japan. 7. Cardiovascular Center, Nihon University Surugadai Hospital, Chiyoda-ku, Tokyo, Japan. 8. Department of Biostatistics, School of Public Health, Kyoto University, Yoshida-konoe, Kyoto, Japan. 9. Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan. 10. Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Abstract
OBJECTIVE: This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms. METHODS: This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes. RESULTS: Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96-0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92-0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival. CONCLUSIONS: While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed.
OBJECTIVE: This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms. METHODS: This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes. RESULTS: Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96-0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92-0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival. CONCLUSIONS: While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed.
Authors: Joshua R Lupton; Robert Schmicker; Mohamud R Daya; Tom P Aufderheide; Shannon Stephens; Nancy Le; Susanne May; Juan Carlos Puyana; Ahamed Idris; Graham Nichol; Henry Wang; Matt Hansen Journal: Resuscitation Date: 2019-03-19 Impact factor: 5.262
Authors: Mohammed A Al-Mulhim; Mohammed S Alshahrani; Laila Perlas Asonto; Ahmad Abdulhady; Talal M Almutairi; Mariam Hajji; Mohammed A Alrubaish; Khalid N Almulhim; Mariam H Al-Sulaiman; Layla B Al-Qahtani Journal: J Int Med Res Date: 2019-07-16 Impact factor: 1.671