Objectives: To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest.
Design: Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score.
Setting: Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010.
Participants: Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT.
Main Outcome Measures: Overall and neurologically intact survival at one month or at discharge, whichever was earlier.
Results: After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT.
Conclusions: Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.
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http://dx.doi.org/10.1136/bmj.f6829 | DOI Listing |
Pharmazie
December 2024
Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan.
This study aimed to determine the risk of emergency admission by ambulance in patients taking potentially inappropriate medications (PIMs). We included 273,932 patients aged over 75 years of age admitted between January 1, 2019, and December 31, 2019, using the Japan Medical Data Center medical insurance database containing anonymized patient data. We excluded patients without a history of admission.
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January 2025
Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China.
Background: The hypobaric hypoxic atmosphere can cause adverse reactions or sickness. The purpose of this study was to explore the preventive effect and mechanism of human umbilical cord mesenchymal stem cells (hUC-MSCs) on acute pathological injury in mice exposed to high-altitude.
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Sports Med Open
January 2025
Institute of Primary Care, University of Zurich, Zurich, Switzerland.
Background: Marathon training and running have many beneficial effects on human health and physical fitness; however, they also pose risks. To date, no comprehensive review regarding both the benefits and risks of marathon running on different organ systems has been published.
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Hypertens Res
January 2025
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; #155 Section 2, Linong Street, Taipei, 112, Taiwan.
To explore the effects of obstructive sleep apnea (OSA) on nocturnal changes in blood pressure (BP), we enrolled 2037 participants who underwent polysomnography (PSG) between 2019 and 2020 and examined BP changes before and after sleep. BP was measured in the evening and the following morning using an electronic wrist sphygmomanometer in the supine position. The severity of OSA was determined by PSG and graded based on the apnea/hypopnea index (AHI).
View Article and Find Full Text PDFPediatr Nephrol
January 2025
Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China.
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a notably common complication in pediatrics, with an incidence rate ranging from 15 to 64%. This rate is significantly higher than that observed in adults. Currently, there is a lack of substantial evidence regarding the association between intraoperative blood pressure variability (BPV) during cardiac surgery with cardiopulmonary bypass (CPB) and the development of AKI in pediatric patients.
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