Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest.
Aged
Ambulances
Cardiopulmonary Resuscitation
/ methods
Drug Administration Schedule
Emergency Medical Services
/ methods
Epinephrine
/ administration & dosage
Female
Humans
London
/ epidemiology
Male
Middle Aged
Out-of-Hospital Cardiac Arrest
/ mortality
Prognosis
Retrospective Studies
Vasoconstrictor Agents
/ administration & dosage
Adrenaline
Epinephrine
Out-of-hospital cardiac arrest
Prehospital
Repeated adrenaline doses
Resuscitation
Journal
Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
30
05
2018
revised:
24
12
2018
accepted:
17
01
2019
pubmed:
2
2
2019
medline:
28
7
2020
entrez:
2
2
2019
Statut:
ppublish
Résumé
Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom. A retrospective review of OHCA treated by the London Ambulance Service over a one year period. Patients aged ≥18 years who received one or more doses of adrenaline (1 mg bolus) during resuscitation were included in the analyses. Outcomes described are survival to hospital discharge and survival to one year post-arrest. Over the one year study period, 3151 patients received adrenaline during OHCA. A significant inverse relationship was found between increasing cumulative doses of adrenaline and survival both to hospital discharge and one year post-arrest. No patients survived after receiving more than ten adrenaline doses. Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.
Sections du résumé
BACKGROUND
Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom.
METHODS
A retrospective review of OHCA treated by the London Ambulance Service over a one year period. Patients aged ≥18 years who received one or more doses of adrenaline (1 mg bolus) during resuscitation were included in the analyses. Outcomes described are survival to hospital discharge and survival to one year post-arrest.
RESULTS
Over the one year study period, 3151 patients received adrenaline during OHCA. A significant inverse relationship was found between increasing cumulative doses of adrenaline and survival both to hospital discharge and one year post-arrest. No patients survived after receiving more than ten adrenaline doses.
CONCLUSION
Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.
Identifiants
pubmed: 30708076
pii: S0300-9572(19)30007-3
doi: 10.1016/j.resuscitation.2019.01.022
pii:
doi:
Substances chimiques
Vasoconstrictor Agents
0
Epinephrine
YKH834O4BH
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
316-321Subventions
Organisme : Department of Health
ID : 12/127/126
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.