Prehospital Epinephrine as a Potential Factor Associated with Prehospital Rearrest.
Prehosp Emerg Care
; 24(6): 741-750, 2020.
Article
em En
| MEDLINE
| ID: mdl-32023141
ABSTRACT
Objective:
To investigate the impact of epinephrine on prehospital rearrest and re-attainment of prehospital return of spontaneous circulation (ROSC).Methods:
Data for 9,292 (≥ 8 years) out-of-hospital cardiac arrest (OHCA) patients transported to hospitals by emergency medical services were collected in Ishikawa Prefecture, Japan during 2010-2018. Univariate and multivariable analyses were retrospectively performed for 1,163 patients with prehospital ROSC.Results:
Of 1,163 patients, rearrest occurred in 272 (23.4%) but not in 891 (76.6%). Both single and multiple doses of epinephrine administered before prehospital ROSC (adjusted odds ratio (OR) 3.62, 95% confidence interval (CI) 2.42-5.46 for 1 mg, and 4.27, 2.58-6.79 for ≥ 2 mg) were main factors associated with rearrest. The association between initial and rearrest rhythms was significantly associated with epinephrine administration (p = 0.02). However, the rearrest rhythm was primarily associated with the initial rhythm (p < 0.01). The majority of patients with the non-shockable initial rhythm had pulseless electrical activity (PEA) as the rearrest rhythm, regardless of epinephrine administration (80.4% for administration, 81.6% for no administration). When the initial rhythm was shockable, the primary rearrest rhythms in patients with and without epinephrine administration before prehospital ROSC were PEA (52.2%) and ventricular fibrillation/pulseless ventricular tachycardia (56.8%), respectively. Only epinephrine administration after rearrest was associated with prehospital re-attainment of ROSC (adjusted OR 2.49, 95% CI 1.20-5.19). Stepwise multivariable logistic regression analyses revealed that neurologically favorable outcome was poorer in patients with rearrest than those without rearrest (9.9% vs. 25.0%, adjusted OR 0.42, 95% CI 0.23-0.73). The total prehospital doses of epinephrine were associated with poorer neurological outcome in a dose-dependent manner (adjusted OR 0.22, 95% CI 0.13-0.36 for 1 mg; 0.09, 0.04-0.19 for 2 mg; 0.03, 0.01-0.09 for ≥ 3 mg, no epinephrine as a reference). Transportation to hospitals with a unit for post-resuscitation care was associated with better neurological outcome (adjusted OR 1.53, 95% CI 1.02-2.32).Conclusions:
The requirement for epinephrine administration before prehospital ROSC was associated with subsequent rearrest. Routine epinephrine administrations and rearrest were associated with poorer neurological outcome of OHCA patients with prehospital ROSC.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Epinefrina
/
Reanimação Cardiopulmonar
/
Serviços Médicos de Emergência
/
Parada Cardíaca Extra-Hospitalar
/
Retorno da Circulação Espontânea
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Humans
País/Região como assunto:
Asia
Idioma:
En
Revista:
Prehosp Emerg Care
Assunto da revista:
MEDICINA DE EMERGENCIA
Ano de publicação:
2020
Tipo de documento:
Article