Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network Approach
Background. The benefit of prehospital epinephrine in out-of-hospital cardiac arrest (OHCA) was shown in a recent large placebo-controlled trial. However, placebo-controlled studies cannot identify the nonpharmacologic influences on concurrent or downstream events that might modify the main effect p...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2020/8057106 |
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| _version_ | 1832547789965361152 |
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| author | Joonghee Kim Yu Jin Kim Sangsoo Han Han Joo Choi Hyungjun Moon Giwoon Kim |
| author_facet | Joonghee Kim Yu Jin Kim Sangsoo Han Han Joo Choi Hyungjun Moon Giwoon Kim |
| author_sort | Joonghee Kim |
| collection | DOAJ |
| description | Background. The benefit of prehospital epinephrine in out-of-hospital cardiac arrest (OHCA) was shown in a recent large placebo-controlled trial. However, placebo-controlled studies cannot identify the nonpharmacologic influences on concurrent or downstream events that might modify the main effect positively or negatively. We sought to identify the real-world effect of epinephrine from a clinical registry using Bayesian network with time-sequence constraints. Methods. We analyzed a prospective regional registry of OHCA where a prehospital advanced life support (ALS) protocol named “Smart ALS (SALS)” was gradually implemented from July 2015 to December 2016. Using Bayesian network, a causal structure was estimated. The effect of epinephrine and SALS program was modelled based on the structure using extended Cox-regression and logistic regression, respectively. Results. Among 4324 patients, SALS was applied to 2351 (54.4%) and epinephrine was administered in 1644 (38.0%). Epinephrine was associated with faster ROSC rate in nonshockable rhythm (HR: 2.02, 6.94, and 7.43; 95% CI: 1.08–3.78, 4.15–11.61, and 2.92–18.91, respectively, for 1–10, 11–20, and >20 minutes) while it was associated with slower rate up to 20 minutes in shockable rhythm (HR: 0.40, 0.50, and 2.20; 95% CI: 0.21–0.76, 0.32–0.77, and 0.76–6.33). SALS was associated with increased prehospital ROSC and neurologic recovery in noncardiac etiology (HR: 5.36 and 2.05; 95% CI: 3.48–8.24 and 1.40–3.01, respectively, for nonshockable and shockable rhythm). Conclusions. Epinephrine was associated with faster ROSC rate in nonshockable rhythm but slower rate in shockable rhythm up to 20 minutes. SALS was associated with improved prehospital ROSC and neurologic recovery in noncardiac etiology. |
| format | Article |
| id | doaj-art-8865e9645413443d84bf4f3e7726d55c |
| institution | Kabale University |
| issn | 2090-2840 2090-2859 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-8865e9645413443d84bf4f3e7726d55c2025-02-03T06:43:25ZengWileyEmergency Medicine International2090-28402090-28592020-01-01202010.1155/2020/80571068057106Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network ApproachJoonghee Kim0Yu Jin Kim1Sangsoo Han2Han Joo Choi3Hyungjun Moon4Giwoon Kim5Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si Gyeonggi-do, Seongnam 13620, Republic of KoreaDepartment of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si Gyeonggi-do, Seongnam 13620, Republic of KoreaDepartment of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro Bucheon-si Gyeonggi-do, Bucheon 14584, Republic of KoreaDepartment of Emergency Medicine, Dankook University Hospital, 201, Manghyang-ro Dongnam-gu, Cheonan-si Chungcheongnam-do, Cheonan 31116, Republic of KoreaDepartment of Emergency Medicine, Soonchunhyang University Hospital, 44, Suncheonhyang 4-gil Dongnam-gu, Cheonan-si Chungcheongnam-do, Asan 31151, Republic of KoreaDepartment of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro Bucheon-si Gyeonggi-do, Bucheon 14584, Republic of KoreaBackground. The benefit of prehospital epinephrine in out-of-hospital cardiac arrest (OHCA) was shown in a recent large placebo-controlled trial. However, placebo-controlled studies cannot identify the nonpharmacologic influences on concurrent or downstream events that might modify the main effect positively or negatively. We sought to identify the real-world effect of epinephrine from a clinical registry using Bayesian network with time-sequence constraints. Methods. We analyzed a prospective regional registry of OHCA where a prehospital advanced life support (ALS) protocol named “Smart ALS (SALS)” was gradually implemented from July 2015 to December 2016. Using Bayesian network, a causal structure was estimated. The effect of epinephrine and SALS program was modelled based on the structure using extended Cox-regression and logistic regression, respectively. Results. Among 4324 patients, SALS was applied to 2351 (54.4%) and epinephrine was administered in 1644 (38.0%). Epinephrine was associated with faster ROSC rate in nonshockable rhythm (HR: 2.02, 6.94, and 7.43; 95% CI: 1.08–3.78, 4.15–11.61, and 2.92–18.91, respectively, for 1–10, 11–20, and >20 minutes) while it was associated with slower rate up to 20 minutes in shockable rhythm (HR: 0.40, 0.50, and 2.20; 95% CI: 0.21–0.76, 0.32–0.77, and 0.76–6.33). SALS was associated with increased prehospital ROSC and neurologic recovery in noncardiac etiology (HR: 5.36 and 2.05; 95% CI: 3.48–8.24 and 1.40–3.01, respectively, for nonshockable and shockable rhythm). Conclusions. Epinephrine was associated with faster ROSC rate in nonshockable rhythm but slower rate in shockable rhythm up to 20 minutes. SALS was associated with improved prehospital ROSC and neurologic recovery in noncardiac etiology.http://dx.doi.org/10.1155/2020/8057106 |
| spellingShingle | Joonghee Kim Yu Jin Kim Sangsoo Han Han Joo Choi Hyungjun Moon Giwoon Kim Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network Approach Emergency Medicine International |
| title | Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network Approach |
| title_full | Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network Approach |
| title_fullStr | Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network Approach |
| title_full_unstemmed | Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network Approach |
| title_short | Effect of Prehospital Epinephrine on Outcomes of Out-of-Hospital Cardiac Arrest: A Bayesian Network Approach |
| title_sort | effect of prehospital epinephrine on outcomes of out of hospital cardiac arrest a bayesian network approach |
| url | http://dx.doi.org/10.1155/2020/8057106 |
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