Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study

Abstract

Objectives To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest.Design Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score.

Effective Pre-hospital Care for Out-of-hospital Cardiac Arrest Caused by Respiratory Disease

“…In previous studies, the relationship between the prognosis of OHCA and pre-hospital care, including the type of bystander CPR, advanced airway management, epinephrine administration, and the use of a public-access automated external defibrillator (AED), has been examined [8][9][10][11][12][13][14][15]. However, studies have often focussed on OHCA with cardiac origin, and no study has thus far solely focussed on OHCA caused by respiratory disease.…”

“…The EMS system in Japan has been described previously [8][9][10][11][12][13][14][15][18][19][20]. In 2010, the Japanese municipal governments provided EMS through 802 fire stations with dispatch centres [21].…”

Katecholamine: Pro und Kontra

“…Neuere randomisierte Studien und auch 2 aktuelle Metaanalysen haben bislang nur Hinweise dafür erbracht, dass die Gabe von Adrenalin bei Herzstillstand außerhalb des Krankenhauses die Herstellung eines Spontankreislaufs fördern kann, das Langzeitüberleben aber nicht positiv beeinflusst [27,55]. Beobachtungsstudien lieferten zur Langzeitprognose widersprüchli-che Aussagen [24,51,54]. In einer aktuellen großen retrospektiven Studie besserte Adrenalin die Langzeitprognose von Patienten mit nichtdefibrillierbaren Arrhythmien, insbesondere, wenn es mög-lichst frühzeitig gegeben wurde [17].…”

Out-of-hospital airway management during manual compression or automated chest compression devices

“…Furthermore, we did not know the type of ACCD and when und how long this device was used. Additionally, the GRR did not document the timing of chest compressions and airway management; recently published studies stated this is important [29,30]; however, the out-of-hospital time interval was nearly the same in the mCC and ACCD groups. In this study major surrogate parameters for successful airway management and ventilation are not reported: oxygen saturation (SaO2) and arterial carbon dioxide (paCO2) at hospital admission.…”