Use of epinephrine for resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with increased odds of return of spontaneous circulation, but does not improve patient outcomes, according to a study published in the March 21 issue of the Journal of the American Medical Association.
To investigate the effectiveness of epinephrine use before hospital arrival, Akihito Hagihara, D.M.Sc., M.P.H., of the Kyushu University Graduate School of Medicine in Fukuoka, Japan, and colleagues analyzed data from 417,188 OHCAs occurring in Japan from 2005 to 2008. Patients (aged 18 years or older) were treated by emergency medical service personnel and transported to the hospital.
The researchers found that the return of spontaneous circulation before hospital arrival was observed in significantly more patients in the epinephrine group compared with the no-epinephrine group (18.5 versus 5.7 percent in all patients; 18.3 versus 10.5 percent in propensity-matched patients). The return of spontaneous circulation was significantly and positively associated with prehospital epinephrine in all patients and in propensity-matched patients (adjusted odds ratio [aOR], 2.36 and 2.51, respectively). Significant negative associations were seen between prehospital epinephrine and long-term outcome measures among all patients and propensity-matched patients (aORs: one-month survival, 0.46 and 0.54, respectively; survival with good or moderate cerebral performance, 0.31 and 0.21, respectively; and survival with no, mild, or moderate neurological disability, 0.32 and 0.23, respectively).
"Among patients with OHCA in Japan, use of prehospital epinephrine was significantly associated with increased chance of return of spontaneous circulation before hospital arrival but decreased chance of survival and good functional outcomes one month after the event," the authors write.
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