Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest

Hagihara, Akihito; Hasegawa, Manabu; Nagata, Takashi; Wakata, Yoshifumi; Miyazaki, Shota

doi:10.1001/jama.2012.294

Cited by 357 publications

(289 citation statements)

References 19 publications

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“…Two of the included studies[18,30] were based on a protocol change in Japan, where emergency life-saving technicians were permitted to establish an intravenous line and administer epinephrine according to Japanese Fire and Disaster Management Agency resuscitation guidelines since 2006. Before this period, epinephrine was administered only when patients were attended by a physician-manned ambulance.…”

Section: Resultsmentioning

confidence: 99%

Epinephrine in out-of-hospital cardiac arrest:A critical review

Reardon¹,

Magee²

2013

World Journal of Emergency Medicine

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BACKGROUND:Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. Yet, despite its long time use and incorporation into guidelines, epinephrine suffers from a paucity of evidence regarding its influence on survival. This critical review was conducted to address the knowledge deficit regarding epinephrine in out-of-hospital cardiac arrest and its effect on return of spontaneous circulation, survival to hospital discharge, and neurological performance.METHODS:The EMBASE and MEDLINE (through the Pubmed interface) databases, and the Cochrane library were searched with the key words “epinephrine”, “cardiac arrest” and variations of these terms. Original research studies concerning epinephrine use in adult, out-of-hospital cardiac arrest were selected for further review.RESULTS:The search yielded nine eligible studies based on inclusion criteria. This includes five prospective cohort studies, one retrospective cohort study, one survival analysis, one case control study, and one RCT. The evidence clearly establishes an association between epinephrine and increased return of spontaneous circulation, the data were conflicting concerning survival to hospital discharge and neurological outcome.CONCLUSIONS:The results of this review exhibit the paucity of evidence regarding the use of epinephrine in out of hospital cardiac arrest. There is currently insufficient evidence to support or reject its administration during resuscitation. Larger sample, placebo controlled, double blind, randomized control trials need to be performed to definitively establish the effect of epinephrine on both survival to hospital discharge and the neurological outcomes of treated patients.

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Section: Resultsmentioning

confidence: 99%

Epinephrine in out-of-hospital cardiac arrest:A critical review

Reardon¹,

Magee²

2013

World Journal of Emergency Medicine

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“…[15,17] In the present study, the patients with total adrenaline ≤5 mg had a better ROSC, survived for 24 hours, survived to hospital discharge, or survived to discharge with favourable neurological outcomes, compared those with total adrenaline >5 mg ( P <0.01), whereas multivariate logistic regression analysis showed that total adrenaline level ≤5 mg was identified as a favorable predictor for ROSC. Currently, a larger number of trials and a randomized controlled trial[23,24] focused on outcomes of CA patients whenever adrenaline given or not. It was verified that adrenaline administration was associated with improved short-term survival (ROSC/being admitted to hospital), but decreased survival to 1 month/hospital discharge and survival with favorable neurological outcome after OHCA.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing outcomes after cardiopulmonary resuscitation in emergency department

Xue¹,

Leng²,

Gao³

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:The outcome of cardiopulmonary resuscitation (CPR) may depend on a variety of factors related to patient status or resuscitation management. To evaluate the factors influencing the outcome of CPR after cardiac arrest (CA) will be conducive to improve the effectiveness of resuscitation. Therefore, a study was designed to assess these factors in the emergency department (ED) of a city hospital.METHODS:A CPR registry conforming to the Utstein-style template was conducted in the ED of the First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2011. The outcomes of CPR were compared in various factors groups. The primary outcomes were rated to return of spontaneous circulation (ROSC), 24-hour survival, survival to discharge and discharge with favorable neurological outcomes. Univariate analysis and multivariable logistic regression analysis were performed to evaluate factors associated with survival.RESULTS:A total of 725 patients were analyzed in the study. Of these patients, 187 (25.8%) had ROSC, 100 (13.8%) survived for 24 hours, 48 (6.6%) survived to discharge, and 23 (3.2%) survived to discharge with favorable neurologic outcomes. A logistic regression analysis demonstrated that the independent predictors of ROSC included traumatic etiology, first monitored rhythms, CPR duration, and total adrenaline dose. The independent predictors of 24-hour survival included traumatic etiology, cardiac etiology, first monitored rhythm and CPR duration. Previous status, cardiac etiology, first monitored rhythms and CPR duration were included in independent predictors of survival to discharge and neurologically favorable survival to discharge.CONCLUSIONS:Shockable rhythms, CPR duration ≤15 minutes and total adrenaline dose ≤5 mg were favorable predictors of ROSC, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms and CPR duration ≤15 minutes were favorable predictors of 24-hour survival, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms, CPR duration ≤15 minutes were favorable predictors of survival to discharge and neurologically favorable survival to discharge, but previous terminal illness or multiple organ failure (MOF) was unfavorable.

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“…Interestingly, in one of the largest observational studies ever, Hagihara and colleagues came to a different conclusion. 15 Among patients with out-of-hospital cardiac arrest, although the use of epinephrine was associated with an improved ROSC, it led to decreased chances of survival and good functional outcomes 1 month after the event. These findings are counterintuitive considering our understanding that this medication improves cerebral and coronary perfusion.…”

Section: Resultsmentioning

confidence: 99%