Departmental Bulletin Paper アドレナリン投与時間の遅れが脳機能予後へ及ぼす影響の検討
The adverse effects of late adrenaline on neurological outcomes of patients experiencing out-of-hospital cardiac arrest

植田, 広樹  ,  田中, 秀治  ,  田久, 浩志  ,  匂坂, 量  ,  曽根, 悦子

OBJECTIVE :Adrenaline is the only vasopressor that can be given in the event of out-of-hospital cardiac arrest (OHCA) according to the Japanese EMS protocol. However, there is little clinical evidence that adrenaline benefits long-term survival after OHCA. The aim of this study was to investigate the effects of early adrenaline administration by EMTs on favorable neurological outcomes among patients who experienced OHCA.METHODS :Potential subjects were a total of 822,250 patients who experienced OHCA between 2006 and 2012 and who were registered in a nationwide Japanese database. Subjects were 40,970 patients who received adrenaline prior to hospital arrival. The effects of the time from contact to the first administration of adrenaline (timing of the first administration of adrenaline, or TAA) on favorable neurological outcomes (a CPC score of 1-2) were evaluated as follows. Patients were divided into three groups based on the TAA (early group (n=18,890:TAA < 7.6 min, intermediate group (n=17,669) : TAA of 7.6 to 15.5 min, and late group (n=4,411):TAA > 15.5 min). Statistical analysis was performed using the crude odds ratio (OR) and 95% confidence interval (CI).RESULTS :Patients in the early group served as a reference. In comparison to the early group, the intermediate group had an OR for a favorable neurological outcome of 0.48 and a CI of 0.40-0.58, and the late group had an OR of 0.24 and a Cl of 0.19-0.29. The early group had significantly improved outcomes (CPC score of 1-2) compared to the late group.CONCLUSION :Adrenaline administered by EMTs significantly improved neurological outcomes in patients during the early stages of OHCA. An exhaustive review of the adrenaline administration protocol for EMTs is needed to increase the likelihood of favorable neurological outcomes in who experiencing OHCA.

Number of accesses :  

Other information