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Effect of Prehospital Epinephrine on Out-of-Hospital Cardiac Arrest Outcomes: A Propensity Score-Matched Analysis

 Eunah Han  ;  Taeyoung Kong  ;  Je Sung You  ;  Incheol Park  ;  Goeun Park  ;  Sujee Lee  ;  Sung Phil Chung 
 YONSEI MEDICAL JOURNAL, Vol.63(2) : 187-194, 2022-02 
Journal Title
Issue Date
Cardiopulmonary Resuscitation* ; Emergency Medical Services* ; Epinephrine / therapeutic use ; Humans ; Out-of-Hospital Cardiac Arrest* / drug therapy ; Pilot Projects ; Propensity Score ; Registries
Epinephrine ; neurological outcome ; out-of-hospital cardiac arrest ; survival
Purpose: A pilot project using epinephrine at the scene under medical control is currently underway in Korea. This study aimed to determine whether prehospital epinephrine administration is associated with improved survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients who received epinephrine during cardiopulmonary resuscitation (CPR) in the emergency department.

Materials and methods: This retrospective observational study used a nationwide multicenter OHCA registry. Patients were classified into two groups according to whether they received epinephrine at the scene or not. The associations between prehospital epinephrine use and outcomes were assessed using propensity score (PS)-matched analysis. Multivariable logistic regression analysis was performed using PS matching. The same analysis was repeated for the subgroup of patients with non-shockable rhythm.

Results: PS matching was performed for 1084 patients in each group. Survival to discharge was significantly decreased in the patients who received prehospital epinephrine [odds ratio (OR) 0.415, 95% confidence interval (CI) 0.250-0.670, p<0.001]. However, no statistical significance was observed for good neurological outcome (OR 0.548, 95% CI 0.258-1.123, p=0.105). For the patient subgroup with non-shockable rhythm, prehospital epinephrine was also associated with lower survival to discharge (OR 0.514, 95% CI 0.306-0.844, p=0.010), but not with neurological outcome (OR 0.709, 95% CI 0.323-1.529, p=0.382).

Conclusion: Prehospital epinephrine administration was associated with decreased survival rates in OHCA patients but not statistically associated with neurological outcome in this PS-matched analysis. Further research is required to investigate the reason for the detrimental effect of epinephrine administered at the scene.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kong, Tae Young(공태영) ORCID logo https://orcid.org/0000-0002-4182-7245
Park, Goeun(박고은)
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
You, Je Sung(유제성) ORCID logo https://orcid.org/0000-0002-2074-6745
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
Han, Eunah(한은아) ORCID logo https://orcid.org/0000-0001-7928-3901
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