Ethan J Lilien, Nicklaus P Ashburn, Tyler S George, Anna C Snavely, Bryan P Beaver, Casey G Costa, Michael A Chado, Harris A Cannon, James E Winslow, R Darrell Nelson, Jason P Stopyra, Simon A Mahler
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Demographics and the outcome of survival were sourced from the Cardiac Arrest Registry to Enhance Survival. Patients were categorized as older (≥ 65 years), middle-aged (46-64 years), and young (18-45 years). Survival rates were compared pre vs. post SDEP implementation within age groups using Generalized Estimating Equations to account for clustering within EMS systems and adjust for sex, race, witnessed arrest, AED application, rhythm type, bystander CPR, arrest location, and EMS response time. The interaction of SDEP implementation with age group was evaluated.</p><p><strong>Results: </strong>Among 1690 patients (899 MDEP, 791 SDEP), 864 were older, 538 were middle-aged, and 288 were young. Survival occurred in 13.6% (122/899) in the MDEP group and 15.4% (122/791) in the SDEP group. SDEP was associated with improved survival in older patients (12.2% [50/409] vs. 6.6% [30/455]; OR: 1.95, 95% CI 1.58-2.41) and similar survival in middle-aged (17.5% [47/268] vs. 18.2% [49/270]; OR: 0.96, 95% CI 0.53-1.25) and young (21.9% [25/114] vs. 24.7% [43/174]; OR: 0.88, 95% CI 0.41-1.90) patients. After adjusting, SDEP remained associated with improved survival among older adults (aOR: 1.87, 95% CI 1.36-2.56) and similar survival rates among middle-aged (aOR: 0.85, 95% CI 0.63-1.15) and young (aOR: 0.82, 95% CI 0.41-1.64) patients. 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引用次数: 0
摘要
背景：最近发现，与多剂量肾上腺素方案（MDEP）相比，单剂量肾上腺素方案（SDEP）治疗院外心脏骤停（OHCA）的生存率与出院生存率相似。目前尚不清楚SDEP和MDEP的存活率是否因年龄而异。本研究旨在确定SDEP方案是否能提高不同年龄组的生存率。方法：我们于2016年11月1日至2019年10月29日在北卡罗来纳州5个EMS系统中对成年OHCA患者进行了实施前和实施后研究（MDEP与SDEP）。人口统计数据和生存结果来源于心脏骤停登记处以提高生存。患者分为老年（≥65岁）、中年（46-64岁）和青年（18-45岁）。使用广义估计方程比较各组实施SDEP前后的生存率，以解释EMS系统内的聚类，并调整性别、种族、目睹骤停、AED应用、节律类型、旁观者CPR、骤停位置和EMS响应时间。评估SDEP实施与年龄组的相互作用。结果：1690例患者（MDEP 899例，SDEP 791例）中，老年864例，中年538例，青年288例。MDEP组生存率为13.6% (122/899)，SDEP组生存率为15.4%（122/791）。SDEP与老年患者的生存率改善相关（12.2%[50/409]对6.6% [30/455];OR: 1.95, 95% CI 1.58-2.41），中年患者的生存率相似（17.5%[47/268]对18.2% [49/270];OR: 0.96, 95% CI 0.53-1.25）和年轻患者（21.9%[25/114]对24.7% [43/174];OR: 0.88, 95% CI 0.41-1.90）。调整后，SDEP仍然与老年人（aOR: 1.87, 95% CI 1.36-2.56）的生存率相关，中年（aOR: 0.85, 95% CI 0.63-1.15）和年轻（aOR: 0.82, 95% CI 0.41-1.64）患者的生存率相似。老年和中年患者（p = 0.001）和老年和年轻患者（p = 0.05）实施SDEP的相互作用表明差异效应。结论：SDEP与老年人生存率的提高有关。
Single Dose Epinephrine Protocol Is Associated With Improved Survival of Older Adults With Out-Of-Hospital Cardiac Arrest.
Background: A single-dose epinephrine protocol (SDEP) for out-of-hospital cardiac arrest (OHCA) was recently found to have similar survival to hospital discharge (survival) rates compared to a multidose epinephrine protocol (MDEP). It remains unknown if survival rates vary for SDEP vs. MDEP by age. This study aims to determine if an SDEP protocol improves survival in distinct age groups.
Methods: We conducted a pre-post implementation study (MDEP vs. SDEP) in 5 North Carolina EMS systems from 11/01/2016-10/29/2019 among adult OHCA patients. Demographics and the outcome of survival were sourced from the Cardiac Arrest Registry to Enhance Survival. Patients were categorized as older (≥ 65 years), middle-aged (46-64 years), and young (18-45 years). Survival rates were compared pre vs. post SDEP implementation within age groups using Generalized Estimating Equations to account for clustering within EMS systems and adjust for sex, race, witnessed arrest, AED application, rhythm type, bystander CPR, arrest location, and EMS response time. The interaction of SDEP implementation with age group was evaluated.
Results: Among 1690 patients (899 MDEP, 791 SDEP), 864 were older, 538 were middle-aged, and 288 were young. Survival occurred in 13.6% (122/899) in the MDEP group and 15.4% (122/791) in the SDEP group. SDEP was associated with improved survival in older patients (12.2% [50/409] vs. 6.6% [30/455]; OR: 1.95, 95% CI 1.58-2.41) and similar survival in middle-aged (17.5% [47/268] vs. 18.2% [49/270]; OR: 0.96, 95% CI 0.53-1.25) and young (21.9% [25/114] vs. 24.7% [43/174]; OR: 0.88, 95% CI 0.41-1.90) patients. After adjusting, SDEP remained associated with improved survival among older adults (aOR: 1.87, 95% CI 1.36-2.56) and similar survival rates among middle-aged (aOR: 0.85, 95% CI 0.63-1.15) and young (aOR: 0.82, 95% CI 0.41-1.64) patients. The interactions of SDEP implementation between older and middle-aged (p = 0.001) and older and young (p = 0.05) patients indicate a differential effect.
Conclusion: SDEP was associated with improved survival rates among older adults.
期刊介绍：
Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine.
The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more.
Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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