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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 Dec 10; 347:f6829.BMJ

Abstract

OBJECTIVES

To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest.

DESIGN

Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score.

SETTING

Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010.

PARTICIPANTS

Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT.

MAIN OUTCOME MEASURES

Overall and neurologically intact survival at one month or at discharge, whichever was earlier.

RESULTS

After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT.

CONCLUSIONS

Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.

Authors+Show Affiliations

Department of Epidemiology and Health Promotion, Saint Marianna University School of Medicine, Kawasaki, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

24326886

Citation

Nakahara, Shinji, 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 (Clinical Research Ed.), vol. 347, 2013, pp. f6829.
Nakahara S, Tomio J, Takahashi H, 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.
Nakahara, S., Tomio, J., Takahashi, H., Ichikawa, M., Nishida, M., Morimura, N., & Sakamoto, T. (2013). 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 (Clinical Research Ed.), 347, f6829. https://doi.org/10.1136/bmj.f6829
Nakahara S, 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 Dec 10;347:f6829. PubMed PMID: 24326886.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Nakahara,Shinji, AU - Tomio,Jun, AU - Takahashi,Hideto, AU - Ichikawa,Masao, AU - Nishida,Masamichi, AU - Morimura,Naoto, AU - Sakamoto,Tetsuya, Y1 - 2013/12/10/ PY - 2013/12/12/entrez PY - 2013/12/12/pubmed PY - 2014/2/4/medline SP - f6829 EP - f6829 JF - BMJ (Clinical research ed.) JO - BMJ VL - 347 N2 - OBJECTIVES: To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest. DESIGN: Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score. SETTING: Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010. PARTICIPANTS: Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT. MAIN OUTCOME MEASURES: Overall and neurologically intact survival at one month or at discharge, whichever was earlier. RESULTS: After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT. CONCLUSIONS: Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/24326886/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_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=24326886 DB - PRIME DP - Unbound Medicine ER -