Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated.
The American journal of emergency medicine · 2017-07-05 · Observational study
Abstract
BACKGROUND: The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. METHODS: This was a prospective observational study. Using data of all out-of-hospital cardiac arrest cases occurring between 2005 and 2013 in Japan, hierarchical logistic regression and conditional logistic regression along with time-dependent propensity matching were performed. Outcome measures were survival and minimal neurological impairment [cerebral performance category (CPC) 1 or 2] at 1month after the event. RESULTS: We analyzed 37,873 cases that met the inclusion criteria. Among propensity-matched patients, advanced airway management and/or prehospital epinephrine use was related to decreased rates of 1-month survival (adjusted odds ratio 0.88, 95% confidence interval 0.80 to 0.97) and CPC (1, 2) (adjusted odds ratio 0.56, 95% confidence interval 0.48 to 0.66). Advanced airway management was related to decreased rates of 1-month survival (adjusted odds ratio 0.89, 95% confidence interval 0.81to 0.98) and CPC (1, 2) (adjusted odds ratio 0.54, 95% confidence interval 0.46 to 0.64) in patients who did not receive epinephrine, whereas epinephrine use was not related to the outcome measures. CONCLUSIONS: In defibrillated patients with OHCA, advanced airway management and/or epinephrine are related to reduced long-term survival, and advanced airway management is less beneficial than epinephrine. However, the proportion of patients with OHCA who responded to an initial shock was very low in the study subjects, and the external validity of our findings might be limited.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Adrenaline · Cardiovascular drugs · Endotracheal intubation · Mortality & survival · Quality of life & function
Related articles
- Sequence of Successful Epinephrine or Advanced Airway Interventions in Nontraumatic Pediatric Out-Of-Hospital Cardiac Arrest. (Acad Emerg Med, 2026)
- Resuscitation Attempt and Outcomes in Patients With Asystole Out-of-Hospital Cardiac Arrest. (JAMA Netw Open, 2024)
- Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. (JAMA Netw Open, 2024)
- Association of prehospital advanced airway and epinephrine with survival in patients with out-of-hospital cardiac arrest. (Sci Rep, 2023)
- Association Between Advanced Airway Management With Adrenaline Injection and Prognosis in Adult Patients With Asystole Asphyxia Out-of-hospital Cardiac Arrest. (J Epidemiol, 2024)
- Prehospital predictors of clinical outcomes in out-of-hospital cardiac arrest with pulseless electrical activity: a JCS-ReSS report. (Resusc Plus, 2026)