title: 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.
abstract: OBJECTIVE
  To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest.
  
  
  METHODS
  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.
  
  
  METHODS
  Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010.
  
  
  METHODS
  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.
  
  
  METHODS
  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: Department of Epidemiology and Health Promotion, Saint Marianna University School of Medicine, Kawasaki, Japan.
authors: Shinji
authors: S
authors: Nakahara
authors: Jun
authors: J
authors: Tomio
authors: Hideto
authors: H
authors: Takahashi
authors: Masao
authors: M
authors: Ichikawa
authors: Masamichi
authors: M
authors: Nishida
authors: Naoto
authors: N
authors: Morimura
authors: Tetsuya
authors: T
authors: Sakamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy* / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013566:Sympathomimetics / Q000008:administration & dosage* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D013566:Sympathomimetics; D004837:Epinephrine