Abstract 102: Epinephrine Administration May Play a Crucial Role in Return of Spontaneous Circulation After Unwitnessed Out-of-Hospital Cardiac Arrest with Asystole on Initial Rhythm
Introduction: It is extremely difficult to achieve return of spontaneous circulation (ROSC) or obtain good neurological outcome in cases of unwitnessed out-of-hospital cardiac arrest (OHCA) with asystole on initial rhythm. The crucial prehospital variables for ROSC after unwitnessed OHCA are not clear.
Hypothesis: We assessed the hypothesis that epinephrine administration before arrival to hospital had significant impact on ROSC after unwitnessed OHCA with asystole on initial rhythm.
Methods: Of 495607 resuscitation-attempted adult patients with OHCAs, 255492 bystander-unwitnessed arrests of all causes with asystole on initial rhythm were analyzed in a prospectively recorded nationwide Utstein-style database in Japan over 5 years (2005-2009). The primary endpoint was prehospital ROSC. The secondary endpoint was 1-month survival after OHCA.
Results: Prehospital ROSC was achieved in 2499 patients. Overall rates of 1-month survival and that with favorable neurological outcome (cerebral performance category =1 or 2) were 0.95% (n=2421) and 0.17% (n=425), respectively. Univariate analysis indicated that age (ROSC group: 68.4±17.5 versus non-ROSC group: 72.8±16.6 years), prehospital AED administration, non-cardiac etiology, intravenous fluid administration, use of advanced life support devices, epinephrine administration, and time from call to arrival at scene (ROSC group: 6.86±3.61 versus non-ROSC group: 7.35±3.89 minutes) were significantly related to achievement of prehospital ROSC. Multivariate logistic regression analysis indicated that the following independent factors had significant impacts on probability of prehospital ROSC: epinephrine administration (odds ratio [OR], 10.57; 95% confidence interval [CI], 9.32-12.01), prehospital AED administration (OR, 2.73; 95% CI, 2.34-3.17), non-cardiac etiology (OR, 1.83; 95% CI, 1.69-2.00), intravenous fluid administration (OR, 1.26; 95% CI, 1.13-1.42), use of advanced life support devices (OR, 1.19; 95% CI, 1.09-1.30), age (OR, 0.99; 95% CI, 0.99-0.99), and time from call to arrival at scene (OR, 0.95; 95% CI, 0.94-0.96).
Conclusions: Epinephrine administration had the strongest association with prehospital ROSC after unwitnessed OHCA with asystole on initial rhythm.
- © 2012 by American Heart Association, Inc.