{"id":1569,"date":"2014-04-13T15:16:42","date_gmt":"2014-04-13T14:16:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=1569"},"modified":"2015-11-12T16:45:19","modified_gmt":"2015-11-12T15:45:19","slug":"pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2014\/04\/13\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\/","title":{"rendered":"Pre-hospital Epinephrine for Witnessed Cardiac Arrest: Improved Outcomes?"},"content":{"rendered":"<p style=\"text-align: justify\"><span style=\"line-height: 1.5em\">Epinepherine remains a common part of resuscitation care for cardiac arrest, despite a lack of clinical evidence to suggest it improves patient survival.\u00a0 This study was a retrospective cohort of patients in Japan with witnessed out-of-hospital cardiac arrest.\u00a0 From this cohort, 1990 matched pairs of patients with initial rhythm of ventricular tachycardia or ventricular fibrillation (VT\/VF) and 9058 pairs with non-VT\/VF were created on the basis of the propensity for administration of epinephrine by emergency medical services.\u00a0 The outcome was survival and neurological status at one month or at discharge.\u00a0 In the propensity matched analysis, epinephrine was associated with greater survival in patients with VF\/VT (17.0% versus 13.4%; adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.13 \u2013 1.63) and in patients with non-VF\/VT arrest (4.0% versus 2.4%; adjusted OR 1.78, 95% CI 1.49 \u2013 2.13).\u00a0 The difference in neurologically intact survival was not significant for VF\/VT (6.6% versus 6.6%) or non-VF\/VT arrest (0.7% versus 0.4%; adjusted OR 1.55, 95% CI 0.99 &#8211; 2.41).<\/span><!--more--><\/p>\n<p style=\"text-align: justify\"><b>Conclusion<\/b><\/p>\n<p style=\"text-align: justify\">Administration of pre-hospital epinephrine for witnessed cardiac arrest is associated with increased overall survival in this propensity matched observational study.\u00a0 However, given the lack of association with neurologically intact survival, questions remain as to whether epinephrine improves outcomes that are desired by patients.\u00a0 Randomized study of this important question is warranted.<\/p>\n<p>\u00a0Summarized by Steven M. Bradley and Preston M. Schneider<\/p>\n<ul>\n<li><span style=\"line-height: 1.5em\">Nakahara S, Tomio J, Takahashi H, et al. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study. <\/span><i style=\"line-height: 1.5em\">BMJ<\/i><span style=\"line-height: 1.5em\">. 2013;347.<\/span><\/li>\n<\/ul>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Epinepherine remains a common part of resuscitation care for cardiac arrest, despite a lack of clinical evidence to suggest it improves patient survival.\u00a0 This study was a retrospective cohort of patients in Japan with witnessed out-of-hospital cardiac arrest.\u00a0 From this cohort, 1990 matched pairs of patients with initial rhythm of ventricular tachycardia or ventricular fibrillation [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/heart\/2014\/04\/13\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":47,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[279],"tags":[],"class_list":["post-1569","post","type-post","status-publish","format-standard","hentry","category-general-cardiology"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pre-hospital Epinephrine for Witnessed Cardiac Arrest: Improved Outcomes? - Heart<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/heart\/2014\/04\/13\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pre-hospital Epinephrine for Witnessed Cardiac Arrest: Improved Outcomes? - Heart\" \/>\n<meta property=\"og:description\" content=\"Epinepherine remains a common part of resuscitation care for cardiac arrest, despite a lack of clinical evidence to suggest it improves patient survival.\u00a0 This study was a retrospective cohort of patients in Japan with witnessed out-of-hospital cardiac arrest.\u00a0 From this cohort, 1990 matched pairs of patients with initial rhythm of ventricular tachycardia or ventricular fibrillation [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/heart\/2014\/04\/13\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\/\" \/>\n<meta property=\"og:site_name\" content=\"Heart\" \/>\n<meta property=\"article:published_time\" content=\"2014-04-13T14:16:42+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-11-12T15:45:19+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2014\\\/04\\\/13\\\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2014\\\/04\\\/13\\\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Pre-hospital Epinephrine for Witnessed Cardiac Arrest: Improved Outcomes?\",\"datePublished\":\"2014-04-13T14:16:42+00:00\",\"dateModified\":\"2015-11-12T15:45:19+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2014\\\/04\\\/13\\\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\\\/\"},\"wordCount\":252,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/#organization\"},\"articleSection\":[\"General cardiology\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2014\\\/04\\\/13\\\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2014\\\/04\\\/13\\\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/heart\\\/2014\\\/04\\\/13\\\/pre-hospital-epinephrine-for-witnessed-cardiac-arrest-improved-outcomes\\\/\",\"name\":\"Pre-hospital Epinephrine for Witnessed Cardiac Arrest: Improved Outcomes? 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