Abstract 14128: Association Between Prehospital First Defibrillation to Administration of Epinephrine Interval and Outcome After Out-of-hospital Cardiac Arrest
Background: In out-of-hospital cardiac arrest (OHCA) patients, although the epinephrine administration after second defibrillation is currently recommended by the AHA guidelines during shockable rhythm, there is insufficient evidence regarding the timing of administration of this agent, particularly in relation to defibrillation. In this study, we evaluated the timing of epinephrine after first defibrillation (Def-Epi interval) was associated with clinical outcome in OHCA patients.
Methods: Between 2005 and 2014, we enrolled 1,176,363 patients from nationwide prospective population-based registry of OHCA in Japan. Following exclusion criteria, a total of 7,816 OHCA patients with witnessed by bystanders with VF on the initial electrocardiogram who administrated epinephrine after defibrillation by emergency medical service personnel were eligible for the study. We evaluated the association between Def-Epi interval and favorable neurological outcome (cerebral performance category: 1 or 2) at 30 days. To evaluate predictor for better neurological outcome, study patients were categorized as every 2 minutes up to 10 minutes, and more than 10 minutes (Table).
Results: Patients with favorable neurological outcome were 8% (N=675). A median time of Def-Epi interval was 8 min. Patients with favorable neurological outcome had a shorter Def-Epi interval than those with non-favorable neurological outcome (8.8±4.6 vs 12.0±6.4 min, p<0.001). Multivariable logistic regression analysis showed that Def-Epi interval at 4 to 5 minutes, when Def-Epi interval at 8 to 9 minutes as defined reference, is a significant predictor for better neurological outcome (Odds ratio 2.14; 95%CI 1.50-3.06, p<0.001) (Table).
Conclusion: Epinephrine administration at 4 to 5 minute after first defibrillation was significantly associated with short-term neurological outcome. In contrast, early epinephrine administration within 2 minutes does not improve neurological outcome.
Author Disclosures: S. Kawakami: None. Y. Tahara: None. T. Noguchi: None. S. Yasuda: None. S. Kojima: None. N. Yonemoto: None. K. Saku: None. H. Nonogi: None. K. Nagao: None.
- © 2016 by American Heart Association, Inc.