Evaluation of out-of-hospital cardiopulmonary resuscitation with resuscitative drugs: a prospective comparative study in Japan.
OBJECTIVE
This study aimed at evaluating two emergency medical service systems, one in which emergency life-saving technicians (ELSTs) are allowed to administer epinephrine (adrenaline) to patients with out-of-hospital cardiac arrest and one in which ELSTs are allowed to administer epinephrine, lidocaine, and atropine.


METHODS
A modified, prospective community health trial was conducted from April 1 to October 31, 2003. Areas served by physician-manned ambulances, where out-of-hospital cardiopulmonary resuscitation (CPR) was performed with resuscitative drugs (experimental areas), were compared to areas served by ELST-manned ambulances, where resuscitative drugs were not administered outside the hospital (reference areas). The sequence of emergency procedures performed in the experimental areas was divided into three phases. Phase I included administration of epinephrine, which simulated administration of epinephrine by ELSTs. Phase II started with the use of lidocaine or atropine. Phases I and II simulated administration of epinephrine, lidocaine, and atropine by ELSTs. Phase III began with administration of another drug. Outcomes, resuscitation rates and 1-month survival rates were determined, and differences between the two types of areas were analyzed.


RESULTS
For non-traumatic cardiac arrest, outcomes through phase II in the experimental areas were significantly better than those in the reference areas. Phase I-only outcomes in the experimental areas were better, but not significantly better, than those in the reference areas.


CONCLUSIONS
Use of resuscitative drugs for non-traumatic prehospital CPR appears to be effective in terms of resuscitation rates and 1-month survival rates.
Department of Public Health, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. kenoh@med.yokohama-cu.ac.jp
Kenji
K
Ohshige
Shuji
S
Shimazaki
Hiroyuki
H
Hirasawa
Masataka
M
Nakamura
Hiroshi
H
Kin
Chiiho
C
Fujii
Kazuo
K
Okuchi
Yasuhiro
Y
Yamamoto
Katsuya
K
Akashi
Junzo
J
Takeda
Takashi
T
Hanyuda
Osamu
O
Tochikubo
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001285:Atropine / Q000008:administration & dosage*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D016009:Chi-Square Distribution; D003663:Decision Trees; D004632:Emergency Medical Services / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D013566:Sympathomimetics / Q000008:administration & dosage*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D013566:Sympathomimetics; D001285:Atropine; D008012:Lidocaine; D004837:Epinephrine