Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients.
OBJECTIVE
To evaluate the time-independent effect of the early administration of epinephrine (EPI) on favorable neurological outcome (as CPC [cerebral performance category] 1-2) at 1 month in patients with out-of-hospital cardiac arrest.


METHODS
A total of 119 639 witnessed cardiac arrest patients from 2008 to 2012 were eligible for this nationwide, prospective, population-based observational study. Patients were divided into EPI group (n = 20 420) and non-EPI group (n = 99 219). To determine the time-dependent effects of EPI, EPI-administered patients were divided into 4 groups as follows: early EPI (5-18 min), intermediate EPI (19-23 min), late EPI (24-29 min), and very late EPI (30-62 min), respectively. Multiple logistic regression analyses and adjusted odds ratios (AORs) were determined for CPC 1-2 at 1 month (primary outcome) and field return of spontaneous circulation (as secondary outcome) among the groups.


RESULTS
The EPI and non-EPI group had identical background, but EPI group shows higher incidence public access defibrillation and emergency medical technician defibrillation delivered than the non-EPI group. The differences were clinically negligible. Higher return of spontaneous circulation rate (18.0%) and lower CPC 1-2 (2.9%) shown in the EPI group than in the non-EPI group (9.4% and 5.2%). In the time dependent analysis, CPC 1 to 2 was greatest in the early EPI group (AOR, 2.49; 95% confidence interval [CI], 1.90-3.27), followed by the intermediate EPI group (AOR, 1.53; 95% CI, 1.14-2.05) then the late EPI group (AOR, 0.71; 95% CI, 0.47-1.08) as reference.


CONCLUSIONS
Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.
Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan. Electronic address: hidetana@kokushikn.ac.jp.
H
H
Tanaka
Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan.
H
H
Takyu
Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan.
R
R
Sagisaka
Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan.
H
H
Ueta
Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan.
Toru
T
Shirakawa
Department of Sports Medicine, Kokushikan University, Tokyo 206-8515, Japan.
Tomoya
T
Kinoshi
Department of Sports Medicine, Kokushikan University, Tokyo 206-8515, Japan.
Hiroyuki
H
Takahashi
Center for disaster medicine, Aichi Medical University, Nagakute 480-1195, Japan.
Takashi
T
Nakagawa
Department of EMS System, Graduate School, Kokushikan University, Tokyo 206-8515, Japan.
Syuji
S
Shimazaki
Department of Emergency Medicine, Singapore General Hospital, Outram 169608, Singapore; Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, College Rd 169857, Singapore.
M
M
Ong Eng Hock
D000368:Aged; D000369:Aged, 80 and over; D004554:Electric Countershock; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D011446:Prospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D014662:Vasoconstrictor Agents; D004837:Epinephrine