Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

Sanae Hosomi; Tetsuhisa Kitamura; Tomotaka Sobue; Ling Zha; Kosuke Kiyohara; Tasuku Matsuyama; Jun Oda

doi:10.3390/jcm11123564

Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

J Clin Med. 2022 Jun 20;11(12):3564. doi: 10.3390/jcm11123564.

Authors

Sanae Hosomi^{1

2}, Tetsuhisa Kitamura², Tomotaka Sobue², Ling Zha², Kosuke Kiyohara³, Tasuku Matsuyama⁴, Jun Oda¹

Affiliations

¹ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita 565-0871, Japan.
² Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan.
³ Department of Food Science, Faculty of Home Economics, Otsuma Women's University, 12 Sanban-cho, Chiyoda-ku, Tokyo 102-8357, Japan.
⁴ Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.

Abstract

The effects of epinephrine administration timing on patients with out-of-hospital cardiac arrest (OHCA) following traffic collisions are unknown. We analyzed the 2013-2019 All-Japan Utstein Registry data of 2024 such patients aged ≥18 years who were resuscitated by emergency medical service (EMS) personnel or bystanders and then transported to medical institutions. Time from 119 call to epinephrine administration was classified into quartiles: Q1 (6-21 min), Q2 (22-26 min), Q3 (27-34 min), and Q4 (35-60 min). Multivariable logistic regression analysis was used to assess the effects of epinephrine administration timing on one-month survival after OHCA. Overall, the one-month survival rates were 3.2% (15/466) in Q1, 1.1% (5/472) in Q2, 1.9% (11/577) in Q3, and 0.2% (1/509) in Q4. Additionally, the one-month survival rate decreased significantly in the Q4 group (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.57) compared with the Q1 group, and the probability of one-month survival decreased as the time from the EMS call to epinephrine administration increased (p-value for trend = 0.009). Only four patients (0.9% [4/466]) with the earliest epinephrine administration showed a good neurological outcome.

Keywords: Japan; mortality; out-of-hospital cardiac arrest; traffic collision; trauma.

Grants and funding

This work was supported by a Grant-in-Aid for Scientific Research © from the Japan Society for the Promotion of Science (18K08886 and 21K09016) to S.H. This study was supported by a scientific research grant from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (22K09139) to T.K.