Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: a retrospective cohort study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Matthew Huei-Ming Ma¹  Shey-Ying Chen¹  Wei-Ting Chen¹  Kah-Meng Chong¹  Chih-Wei Yang³  Edward Pei-Chuan Huang¹  Hui-Chih Wang¹  Ming-Ju Hsieh¹  Patrick Chow-In Ko¹  Shi-Yi Chen²  Wen-Chu Chiang¹ 

[1] Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei 100, Zhongzheng District, Taiwan;Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan;Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan

关键词: Epinephrine (Adrenaline);    Emergency medical service (EMS);    Out-of-hospital cardiac arrest (OHCA);    Traumatic cardiac arrest (TCA);   

Others  :  1235303
DOI  :  10.1186/s13049-015-0181-4

 received in 2015-03-23, accepted in 2015-11-06,  发布年份 2015

【 摘 要 】

Background

Prehospital resuscitation for patients with major trauma emphasizes a load-and-go principle. For traumatic cardiac arrest (TCA) patients, the administration of vasopressors remains under debate. This study evaluated the effectiveness of epinephrine in the prehospital setting for patients with TCA.

Methods

We conducted a retrospective cohort study using a prospectively collected registry for out-of-hospital cardiac arrest in Taipei. Enrollees were ≥18 years of age with TCA. Patients with signs of obvious death like decapitation or rigor mortis were excluded. Patients were grouped according to prehospital administration, or lack thereof, of epinephrine. Outcomes were sustained (≥2 h) recovery of spontaneous circulation (ROSC) and survival to discharge. A subgroup analysis was performed by stratified total prehospital time.

Results

From June 1 2010 to May 31 2013, 514 cases were enrolled. Epinephrine was administered in 43 (8.4 %) cases. Among all patients, sustained ROSC and survival to discharge was 101 (19.6 %) and 20 (3.9 %), respectively. The epinephrine group versus the non-epinephrine group had higher sustained ROSC (41.9 % vs. 17.6 %, p < 0.01) and survival to discharge (14.0 % vs. 3.0 %, p < 0.01). The adjusted odds ratios (ORs) of epinephrine effect were 2.24 (95 % confidence interval (CI) 1.05-4.81) on sustained ROSC, and 2.94 (95 % CI 0.85-10.15) on survival to discharge. Subgroup analysis showed increased ORs of epinephrine effect on sustained ROSC with a longer prehospital time.

Conclusion

Among adult patients with TCA in an Asian metropolitan area, administration of epinephrine in the prehospital setting was associated with increased short-term survival, especially for those with a longer prehospital time.

【 授权许可】

   
2015 Chiang et al.

【 图 表 】

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【 参考文献 】

• [1]Nolan JP, Hazinski MF, Billi JE, Boettiger BW, Bossaert L, de Caen AR et al.. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2010; 81 Suppl 1:e1-e25.
• [2]David J-S, Gueugniaud P-Y, Riou B, Pham E, Dubien PY, Goldstein P et al.. Does the prognosis of cardiac arrest differ in trauma patients? Crit Care Med. 2007; 35:2251-5.
• [3]Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain NE, Krohmer J. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. J Am Coll Surg. 2003; 196:106-112.
• [4]Martin SK, Shatney CH, Sherck JP, Ho C-C, Homan SJ, Neff J. Blunt Trauma Patients with Prehospital Pulseless Electrical Activity (PEA): Poor Ending Assured. J Trauma Acute Care Surg. 2002; 53:876-881.
• [5]Shimazu S, Shatney CH. Outcomes of trauma patients with no vital signs on hospital admission. J Trauma. 1983; 23:213-216.
• [6]Stratton SJ, Brickett K, Crammer T. Prehospital Pulseless, Unconscious Penetrating Trauma Victims: Field Assessments Associated with Survival. J Trauma Acute Care Surg. 1998; 45:96-100.
• [7]Velmahos GC, Degiannis E, Souter I, Allwood AC, Saadia R. Outcome of a strict policy on emergency department thoracotomies. Archives of surgery (Chicago, Ill: 1960). 1995; 130:774-777.
• [8]Harris T, Masud S, Lamond A, Abu-Habsa M. Traumatic cardiac arrest: a unique approach. Eur J Emerg Med 2014, Aug 26. [Epub ahead of print].
• [9]Varvarousi G, Johnson EO, Goulas S, Agrogiannis G, Valsamakis N, Perrea D et al.. Combination pharmacotherapy improves neurological outcome after asphyxial cardiac arrest. Resuscitation. 2012; 83:527-32.
• [10]Cohn SM, DeRosa M, McCarthy J, Song J, White C, Louden C et al.. Characterizing vasopressin and other vasoactive mediators released during resuscitation of trauma patients. J Trauma Acute Care Surg. 2013; 75:620-8.
• [11]Leis CC, Hernandez CC, Blanco MJ, Paterna PC, Hernandez Rde E, Torres EC. Traumatic cardiac arrest: should advanced life support be initiated? J Trauma Acute Care Surg. 2013; 74:634-638.
• [12]Kowalenko T, Stern S, Dronen S, Wang X. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma. 1992; 33:349-353.
• [13]Liu L, Tian K, Xue M, Zhu Y, Lan D, Peng X et al.. Small doses of arginine vasopressin in combination with norepinephrine “buy” time for definitive treatment for uncontrolled hemorrhagic shock in rats. Shock. 2013; 40:398-406.
• [14]Neset A, Nordseth T, Kramer-Johansen J, Wik L, Olasveengen TM. Effects of adrenaline on rhythm transitions in out-of-hospital cardiac arrest. Acta Anaesthesiol Scand. 2013; 57:1260-1267.
• [15]Donnino MW, Salciccioli JD, Howell MD, Cocchi MN, Giberson B, Berg K et al.. Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ. 2014; 348:g3028.
• [16]Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation. 2011; 82:1138-1143.
• [17]Paradis NA, Martin GB, Rivers EP, Goetting MG, Appleton TJ, Feingold M et al.. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. Jama. 1990; 263:1106-13.
• [18]Callaway CW. Epinephrine for cardiac arrest. Curr Opin Cardiol. 2013; 28:36-42.
• [19]Beloncle F, Meziani F, Lerolle N, Radermacher P, Asfar P. Does vasopressor therapy have an indication in hemorrhagic shock? Ann Intensive Care. 2013; 3:1-6. BioMed Central Full Text
• [20]Nakahara S, Tomio J, Takahashi H, Ichikawa M, Nishida M, Morimura N et al.. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study. BMJ. 2013; 347:f6829.
• [21]Chiang WC, Ko PC, Wang HC, Yang CW, Shih FY, Hsiung KH et al.. EMS in Taiwan: past, present, and future. Resuscitation. 2009; 80:9-13.
• [22]Chiang WC, Ko PC, Chang AM, Chen WT, Liu SS, Huang YS et al.. Bystander-initiated CPR in an Asian metropolitan: does the socioeconomic status matter? Resuscitation. 2014; 85:53-8.
• [23]Dutton RP. Controlled hypotension for spinal surgery. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2004; 13 Suppl 1:S66-S71.
• [24]Grmec S, Strnad M, Cander D, Mally S. A treatment protocol including vasopressin and hydroxyethyl starch solution is associated with increased rate of return of spontaneous circulation in blunt trauma patients with pulseless electrical activity. Int J Emerg Med. 2008; 1:311-316.
• [25]Branney SW, Moore EE, Feldhaus KM, Wolfe RE. Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma. 1998; 45:87-94.
• [26]Lundy DJ, Ross SE, Schorr C, Jones AE, Trzeciak S. Outcomes of trauma victims with cardiac arrest who survive to intensive care unit admission. J Trauma. 2011; 71:E12-E16.
• [27]Schadt JC, Lodbrook J. Hemodynamic and neurohumoral responses to acute hypovolemia in conscious mammals. Am J Physiol. 1991; 260:H305-H318.