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Effect of prehospital epinephrine on out-of-hospital cardiac arrest: a report from the national out-of-hospital cardiac arrest data registry in Japan, 2011–2012

Abstract

Purpose

The effect of prehospital epinephrine on neurological outcome in out-of-hospital cardiac arrest (OHCA) is still controversial. We sought to determine whether prehospital epinephrine administration was associated with improved outcomes in adult OHCA.

Methods

A nationwide, population-based, propensity score-matched study of OHCA patients from January 1, 2011, to December 31, 2012, in Japan was conducted. We included adult OHCA patients treated by emergency medical service personnel without an excessive delay. The primary outcome was neurologically favorable survival 1 month after OHCA.

Results

A total of 237,068 patients (16,616 with a shockable rhythm and 220,452 with a non-shockable rhythm) were included in the final cohort. A total of 4024 out of the 16,616 shockable OHCAs and 29,393 out of the 220,452 non-shockable OHCAs received prehospital epinephrine. In the propensity score-matched cohort, prehospital epinephrine was associated with a decreased chance of neurologically favorable survival (shockable OHCA 7.6 vs. 17.9 %, OR 0.38 [95%CI 0.33–0.43]; non-shockable OHCA 0.6 vs. 1.2 %, OR 0.47 [95%CI 0.39–0.56]). In the subgroup analyses, prehospital epinephrine was significantly associated with poor neurological outcome in all subgroups. In the ancillary analyses, although the neurological outcome was worse as the number of epinephrine doses increased or the time to epinephrine increased, patients had a greater chance of a favorable neurological outcome only when a single dose of epinephrine was administered within 15 min of the emergency call in shockable OHCA.

Conclusions

Among adult OHCA patients, prehospital epinephrine was associated with a decreased chance of neurologically favorable survival. Situations in which prehospital epinephrine is effective may be extremely limited.

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Acknowledgments

This study was supported by the University of Tokyo. We thank all of the EMS personnel and participating physicians in Japan as well as the FDMA for their generous cooperation in establishing and maintaining the All-Japan Utstein Registry. The FDMA oversees/approves data queries and manuscript submissions. However, the author group is responsible for the conception of the project, all data analyses, and manuscript writing. TF, as the principal investigator, participated in the study concept and design; acquisition, analysis, or interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content. O-F N, MT, GM, KY, and YN participated in acquisition, analysis, or interpretation of data and critical revision of the manuscript for important intellectual content. TF performed statistical analysis. All authors approved the final version. TF had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Tatsuma Fukuda.

Ethics declarations

This study was conducted in accordance with the amended Declaration of Helsinki. The institutional review board of the University of Tokyo approved the study with a waiver of informed consent because of the anonymous nature of the data (no. 10096).

Conflict of interest

The authors declare that they have no competing interests.

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Fukuda, T., Ohashi-Fukuda, N., Matsubara, T. et al. Effect of prehospital epinephrine on out-of-hospital cardiac arrest: a report from the national out-of-hospital cardiac arrest data registry in Japan, 2011–2012. Eur J Clin Pharmacol 72, 1255–1264 (2016). https://doi.org/10.1007/s00228-016-2093-2

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  • DOI: https://doi.org/10.1007/s00228-016-2093-2

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Epinephrine
  • Adrenaline
  • Epidemiology