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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2015

Open Access 01-12-2015 | Original research

Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: a retrospective cohort study

Authors: Wen-Chu Chiang, Shi-Yi Chen, Patrick Chow-In Ko, Ming-Ju Hsieh, Hui-Chih Wang, Edward Pei-Chuan Huang, Chih-Wei Yang, Kah-Meng Chong, Wei-Ting Chen, Shey-Ying Chen, Matthew Huei-Ming Ma

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2015

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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.

Conclusion

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.
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Metadata
Title
Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: a retrospective cohort study
Authors
Wen-Chu Chiang
Shi-Yi Chen
Patrick Chow-In Ko
Ming-Ju Hsieh
Hui-Chih Wang
Edward Pei-Chuan Huang
Chih-Wei Yang
Kah-Meng Chong
Wei-Ting Chen
Shey-Ying Chen
Matthew Huei-Ming Ma
Publication date
01-12-2015
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-015-0181-4

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Editorial

Service as joint editor-in-chief for 11 years comes to an end: adieu, godspeed and auf wiedersehn!