• Yosuke Homma, Takashi Shiga, Hiraku Funakoshi, Dai Miyazaki, Atsushi Sakurai, Yoshio Tahara, Ken Nagao, Naohiro Yonemoto, Arino Yaguchi, Naoto Morimura, and SOS-KANTO 2012 Study Group.
• Department of Emergency Medicine and Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan. Electronic address: yousukeh@jadecom.jp.
• Am J Emerg Med. 2019 Feb 1; 37 (2): 241-248.

ObjectiveThis study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms.MethodsThis was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes.ResultsOf the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96-0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92-0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival.ConclusionsWhile assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed.Copyright © 2018 Elsevier Inc. All rights reserved.

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