title: Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: a retrospective cohort study.
abstract: BACKGROUND
  Prehospital resuscitation for patients with major trauma emphasizes a load-and-go principle. For traumatic cardiac arrest (TCA) patients, the administration of vasopressors remains under debate. This study evaluated the effectiveness of epinephrine in the prehospital setting for patients with TCA.
  
  
  METHODS
  We conducted a retrospective cohort study using a prospectively collected registry for out-of-hospital cardiac arrest in Taipei. Enrollees were ≥18 years of age with TCA. Patients with signs of obvious death like decapitation or rigor mortis were excluded. Patients were grouped according to prehospital administration, or lack thereof, of epinephrine. Outcomes were sustained (≥2 h) recovery of spontaneous circulation (ROSC) and survival to discharge. A subgroup analysis was performed by stratified total prehospital time.
  
  
  RESULTS
  From June 1 2010 to May 31 2013, 514 cases were enrolled. Epinephrine was administered in 43 (8.4%) cases. Among all patients, sustained ROSC and survival to discharge was 101 (19.6%) and 20 (3.9%), respectively. The epinephrine group versus the non-epinephrine group had higher sustained ROSC (41.9% vs. 17.6%, p < 0.01) and survival to discharge (14.0% vs. 3.0%, p < 0.01). The adjusted odds ratios (ORs) of epinephrine effect were 2.24 (95% confidence interval (CI) 1.05-4.81) on sustained ROSC, and 2.94 (95% CI 0.85-10.15) on survival to discharge. Subgroup analysis showed increased ORs of epinephrine effect on sustained ROSC with a longer prehospital time.
  
  
  CONCLUSIONS
  Among adult patients with TCA in an Asian metropolitan area, administration of epinephrine in the prehospital setting was associated with increased short-term survival, especially for those with a longer prehospital time.
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Chiang
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.|Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Shi-Yi
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Patrick Chow-In
authors.initials: PC
authors.lastname: Ko
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Hsieh
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Hui-Chih
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Edward Pei-Chuan
authors.initials: EP
authors.lastname: Huang
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.|Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Kah-Meng
authors.initials: KM
authors.lastname: Chong
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chen
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan.
authors.forename: Shey-Ying
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Department of Emergency, National Taiwan University Hospital, No. 7 Zhung-Zhan S. Road, Taipei, Zhongzheng District, 100, Taiwan. mattma.tw@gmail.com.
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004632:Emergency Medical Services / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine