Author + information
- Received July 1, 2019
- Revision received October 22, 2019
- Accepted October 23, 2019
- Published online January 13, 2020.
- Tasuku Matsuyama, MD, PhDa,∗ (, )
- Sho Komukai, PhDb,
- Junichi Izawa, MD, DrPHc,
- Koichiro Gibo, MD, MScd,
- Masashi Okubo, MD, MSe,
- Kosuke Kiyohara, DPHf,
- Takeyuki Kiguchi, MD, PhDg,
- Taku Iwami, MD, PhDg,
- Bon Ohta, MD, PhDa and
- Tetsuhisa Kitamura, MD, DPHh
- aDepartment of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- bDivision of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- cCenter for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- dDepartment of Emergency Medicine, Okinawa Chubu Hospital, Okinawa, Japan
- eDepartment of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- fDepartment of Food Science, Otsuma Women’s University, Tokyo, Japan
- gKyoto University Health Service, Kyoto, Japan
- hDivision of Environmental Medicine and Population Services, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- ↵∗Address for correspondence:
Dr. Tasuku Matsuyama, Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
Background There is little evidence about pre-hospital advanced life support including epinephrine administration for pediatric out-of-hospital cardiac arrests (OHCAs).
Objectives This study aimed to assess the effect of pre-hospital epinephrine administration by emergency-medical-service (EMS) personnel for pediatric OHCA.
Methods This nationwide population-based observational study in Japan enrolled pediatric patients age 8 to 17 years with OHCA between January 2007 and December 2016. Patients were sequentially matched with or without epinephrine during cardiac arrest using a risk-set matching based on time-dependent propensity score (probability of receiving epinephrine) calculated at each minute after initiation of cardiopulmonary resuscitation by EMS personnel. The primary endpoint was 1-month survival. Secondary endpoints were 1-month survival with favorable neurological outcome, defined as the cerebral performance category scale of 1 or 2, and pre-hospital return of spontaneous circulation (ROSC).
Results During the study period, a total of 1,214,658 OHCA patients were registered, and 3,961 pediatric OHCAs were eligible for analyses. Of these, 306 (7.7%) patients received epinephrine and 3,655 (92.3%) did not receive epinephrine. After time-dependent propensity score-sequential matching, 608 patients were included in the matched cohort. In the matched cohort, there were no significant differences between the epinephrine and no epinephrine groups in 1-month survival (epinephrine: 10.2% [31 of 304] vs. no epinephrine: 7.9% [24 of 304]; risk ratio [RR]: 1.13 [95% confidence interval (CI): 0.67 to 1.93]) and favorable neurological outcome (epinephrine: 3.6% [11 of 304] vs. no epinephrine: 2.6% [8 of 304]; RR: 1.56 [95% CI: 0.61 to 3.96]), whereas the epinephrine group had a higher likelihood of achieving pre-hospital ROSC (epinephrine: 11.2% [34 of 304] vs. no epinephrine: 3.3% [10 of 304]; RR: 3.17 [95% CI: 1.54 to 6.54]).
Conclusions In this study, pre-hospital epinephrine administration was associated with ROSC, whereas there were no significant differences in 1-month survival and favorable neurological outcome between those with and without epinephrine.
- out-of-hospital cardiac arrest
- time-dependent propensity score-sequential matching analysis
This study was supported by Japan Society for the Promotion of Science KAKENHI Grant Numbers 15H05006 and 19K09393; and by the Clinical Investigator’s Research Project in Osaka University Graduate School of Medicine. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 1, 2019.
- Revision received October 22, 2019.
- Accepted October 23, 2019.
- 2020 American College of Cardiology Foundation
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