Advertisement

Evaluation of out-of-hospital cardiopulmonary resuscitation with resuscitative drugs: a prospective comparative study in Japan

      Abstract

      Objective:

      This study aimed at evaluating two emergency medical service systems, one in which emergency life-saving technicians (ELSTs) are allowed to administer epinephrine (adrenaline) to patients with out-of-hospital cardiac arrest and one in which ELSTs are allowed to administer epinephrine, lidocaine, and atropine.

      Methods:

      A modified, prospective community health trial was conducted from April 1 to October 31, 2003. Areas served by physician-manned ambulances, where out-of-hospital cardiopulmonary resuscitation (CPR) was performed with resuscitative drugs (experimental areas), were compared to areas served by ELST-manned ambulances, where resuscitative drugs were not administered outside the hospital (reference areas). The sequence of emergency procedures performed in the experimental areas was divided into three phases. Phase I included administration of epinephrine, which simulated administration of epinephrine by ELSTs. Phase II started with the use of lidocaine or atropine. Phases I and II simulated administration of epinephrine, lidocaine, and atropine by ELSTs. Phase III began with administration of another drug. Outcomes, resuscitation rates and 1-month survival rates were determined, and differences between the two types of areas were analyzed.

      Results:

      For non-traumatic cardiac arrest, outcomes through phase II in the experimental areas were significantly better than those in the reference areas. Phase I—only outcomes in the experimental areas were better, but not significantly better, than those in the reference areas.

      Conclusion:

      Use of resuscitative drugs for non-traumatic prehospital CPR appears to be effective in terms of resuscitation rates and 1-month survival rates.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Part III. Adult advanced cardiac life support. JAMA 1992;268:2199–241.

        • Cummins R.O.
        • Ornato J.P.
        • Thies W.H.
        • Pepe P.E.
        Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee. American Heart Association.
        Circulation. 1991; 83: 1832-1847
        • Kowalski R.
        • Thompson B.M.
        • Horwitz L.
        • Stueven H.
        • Aprahamian C.
        • Darin J.C.
        Bystander CPR in prehospital coarse ventricular fibrillation.
        Ann Emerg Med. 1984; 13: 1016-1020
        • Cummins R.O.
        • Eisenberg M.S.
        Prehospital cardiopulmonary resuscitation: is it effective?.
        JAMA. 1985; 253: 2408-2412
        • Mashiko K.
        • Otsuka T.
        • Shimazaki S.
        • et al.
        An outcome study of out-of-hospital cardiac arrest using the Utstein template: a Japanese experience.
        Resuscitation. 2002; 55: 241-246
        • De Maio V.J.
        • Stiell I.G.
        • Wells G.A.
        • Spaite D.W.
        • Ontario Prehospital Advanced Life Support Study Group
        Optimal defibrillation response intervals for maximum out-of-hospital cardiac arrest survival rates.
        Ann Emerg Med. 2003; 42: 242-250
      2. Advanced Life Support Working Group of the European Resuscitation Council. The 1998 European Resuscitation Council guidelines for adult advanced life support. BMJ 1998;316:1863–69.

        • Holmberg M.
        • Holmberg S.
        • Herlitz J.
        Low chance of survival among patients requiring adrenaline (epinephrine) or intubation after out-of-hospital cardiac arrest in Sweden.
        Resuscitation. 2002; 54: 37-45
        • Tang W.
        • Weil M.H.
        • Sun S.
        • Noc M.
        • Yang L.
        • Gazmuri R.J.
        Epinephrine increases the severity of postresuscitation myocardial dysfunction.
        Circulation. 1995; 92: 3089-3093
        • Callaham M.
        • Madsen C.D.
        • Barton C.W.
        • Saunders C.E.
        • Pointer J.
        A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest.
        JAMA. 1992; 268: 2667-2672
        • Herlitz J.
        • Ekström L.
        • Wennerblom B.
        • Axelsson Å.
        • Bång A.
        • Holmberg S.
        Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?.
        Resuscitation. 1995; 29: 195-201
        • Woodhouse S.P.
        • Cox S.
        • Boyd P.
        • Case C.
        • Weber M.
        High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest.
        Resuscitation. 1995; 30: 243-249
        • Nishiuchi T.
        • Hiraide A.
        • Hayashi Y.
        • et al.
        Incidence and survival rate of bystander-witnessed out-of-hospital cardiac arrest with cardiac etiology in Osaka, Japan: a population-based study according to the Utstein style.
        Resuscitation. 2003; 59: 329-335
        • Moriwaki Y.
        • Sugiyama M.
        • Hayashi H.
        • et al.
        Emergency medical services in Yokohama, Japan.
        Annali deli Ospedali San Camillo e Forlanini. 2001; 3: 344-356
        • Pauker S.G.
        Coronary artery surgery: the use of decision analysis.
        Ann Intern Med. 1976; 85: 8-18
        • Jones M.J.
        Decision analysis using spreadsheets.
        Eur J Operat Res. 1986; 26: 385-400
        • Dowie R.
        • Campbell H.
        • Donohoe R.
        • Clarke P.
        ‘Event tree’ analysis of out-of hospital cardiac arrest data: confirming the importance of bystander CPR.
        Resuscitation. 2003; 56: 173-181
        • Nikkanen H.E.
        • Pouges C.
        • Jacobs L.M.
        Emergency medicine in France.
        Ann Emerg Med. 1998; 31: 116-120
        • Moecke H.
        Emergency medicine in Germany.
        Ann Emerg Med. 1998; 31: 111-115
        • Guly U.M.
        • Mitchell R.G.
        • Cook R.
        • Steedman D.J.
        • Robertson C.E.
        Paramedics and technicians are equally successful at managing cardiac arrest outside hospital.
        BMJ. 1995; 310: 1091-1094
        • Larsen M.P.
        • Eisenberg M.S.
        • Cummins R.O.
        • Hallstrom A.P.
        Predicting survival from out-of-hospital cardiac arrest: a graphic model.
        Ann Emerg Med. 1993; 22: 1652-1658