Abstract 92: Effect of Epinephrine Administration During Out-of-Hospital Cardiac Arrest: a Nationwide, Population-Based Cohort Study
Effectiveness of prehospital epinephrine administration remains controversial. The aim of this study was to compare the outcome of cardiac arrest patients with and without prehospital epinephrine administration .
Methods: A matched case-control study was performed on adult patients with out-of-hospital cardiac arrest between January 2005 and December 2007 in Japan. All data were collected according to the Utstein-style guidelines. We excluded patients younger than 18 years, EMT-witnessed cardiac arrest and traumatic or malignancy-related cardiac arrest.The patients was stratified according to the initial rhythm on ECG, and association of epinephrine administration with return of spontaneous circulation (ROSC) and favorable neurological outcome at 1 month post-arrest was analyzed separately. Cases were matched using propensity score and conditional logistic regression modeling techniques were used to estimate the association of epinephrine administration with outcomes after adjusting for age, gender, etiology of cardiac arrest, bystander CPR, layperson AED use, use of advanced airway devices and response time.
Resuslts: Out of 231,410 eligible patients, 350 patients were enrolled into the VF/VT cohort, 1,604 were enrolled into the PEA cohort, and 3,138 into the asystole cohort after case-matching. The relative risk of epinephrine administration in each of the cohorts are shown in the table.
Discussion: Prehospital epinephrine administration increased the rate of ROSC in the PEA cohort and the asystole cohort, but not in the VF/VT cohort. Epinephrine administration adversely affected the favorable neurological outcome in all cohorts.
- © 2010 by American Heart Association, Inc.