肾上腺素治疗外伤性心脏骤停：PARAMEDIC2试验的事后分析

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-02-04 DOI:10.1016/j.resplu.2025.100890

C. Ji , H. Pocock , C.D. Deakin , T. Quinn , J.P. Nolan , N. Rees , K. Charlton , J. Finn , A. Rosser , R. Lall , G.D. Perkins

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引用次数: 0

摘要

关于肾上腺素治疗外伤性心脏骤停的有效性存在争议。本研究报告了创伤性院外心脏骤停的成人患者的特征和结果，这些患者接受肾上腺素或安慰剂治疗。方法：这项院前随机评估心脏骤停患者肾上腺素-2 （paramdic -2）试验的事后亚组分析探讨了肾上腺素对院外创伤相关心脏骤停成人患者存活至入院、长期生存和神经系统预后的影响。个体患者通过打开单个治疗包随机分组，其中包含10剂量的1mg肾上腺素或0.9%生理盐水安慰剂。治疗临床医生、研究者、结果评估者和患者对治疗分配不知情。主要终点是心脏骤停后30天的生存。结果8014例入组患者中有123例（1.5%）发生外伤性心脏骤停（肾上腺素组66例，安慰剂组57例）。肾上腺素组16/66（24.2%）和安慰剂组5/56（8.9%）的患者存活入院人数是安慰剂组的3倍，未经调整的优势比为3.3(95%可信区间1.1 ~ 9.6),p = 0.03；校正奇数比5.6 (95% CI 1.6 ~ 20.4), p = 0.009。肾上腺素组有1例患者存活超过30天(1/66(1.5%)，对照组为0/57(0%))，且神经系统预后良好。结论肾上腺素可使患者存活至住院的比率提高3倍。这些数据支持肾上腺素在院外心脏骤停相关创伤中的应用。

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Adrenaline for traumatic cardiac arrest: A post hoc analysis of the PARAMEDIC2 trial

Introduction

There is controversy about the effectiveness of adrenaline in traumatic cardiac arrest. This study reports the patient characteristics and outcomes of adults with trauma-related out of hospital cardiac arrest treated with adrenaline or placebo.

Methods

This post-hoc, sub-group analysis of the Pre-hospital Randomised Assessment of Adrenaline in Cardiac Arrest-2 (PARAMEDIC-2) trial explored the effect of adrenaline on survival to hospital admission, longer-term survival and neurological outcomes amongst adults with trauma related out of hospital cardiac arrest. Individual patients were randomised through opening a single treatment pack which contained either 10 doses of 1 mg adrenaline or 0.9% saline placebo. Treating clinicians, investigators, outcome assessors and patients were blinded to treatment allocation. The primary outcome was survival to 30 days post cardiac arrest.

Results

123 of 8,014 enrolled patients (1.5%) sustained a traumatic cardiac arrest (66 in the adrenaline arm and 57 in the placebo arm). Three times as many patients were admitted to hospital alive in the adrenaline arm 16/66 (24.2%) compared to 5/56 (8.9%) in the placebo arm, unadjusted odds ratio 3.3 (95% confidence interval 1.1 to 9.6), p = 0.03; adjusted odd ratio 5.6 (95% CI 1.6 to 20.4), p = 0.009. A single patient, in the adrenaline arm, survived beyond 30 days (1/66 (1.5%) compared to 0/57 (0%)), who also experienced a favourable neurological outcome.

Conclusion

Adrenaline was associated with a trebling of the rate of survival to hospital admission. These data support the use of adrenaline in trauma related out of hospital cardiac arrest.