Prehospital epinephrine as a bridge to survival in traumatic cardiac arrest: A nationwide propensity score-matched analysis.

BACKGROUND

This study investigated the association between prehospital intravenous epinephrine use and outcomes of traumatic cardiac arrest using propensity score matching in a nationwide registry.

METHODS

Data of adult patients with traumatic cardiac arrest from the Korean Out-of-Hospital Cardiac Arrest Registry (2015-2021) were analyzed. Patients with non-traumatic etiologies or cardiopulmonary resuscitation durations of <1 or >30 min were excluded. Prehospital epinephrine was administered. The primary outcome was survival to hospital discharge, while the secondary outcomes were prehospital return of spontaneous circulation (ROSC) and favorable neurological outcomes (Cerebral Performance Category (CPC) 1-2). Propensity score matching (1:1) and multivariate logistic regression analyses were performed using clinically relevant covariates.

RESULTS

Among the 22,105 eligible patients, 809 (3.7%) received prehospital epinephrine. After propensity score matching, 1614 patients (807 matched pairs) were analyzed. Prehospital epinephrine administration was associated with higher rates of survival to hospital discharge (5.1% vs. 2.6%, adjusted odds ratio (OR) 1.38, 95% confidence interval (CI): 1.36-1.39) and prehospital ROSC (12.8% vs. 4.5%, adjusted OR 3.63, 95% CI: 2.39-5.51). The association with favorable neurological outcomes was observed only after multivariable adjustment (1.0% vs. 0.5%, adjusted OR 1.11, 95% CI: 1.10-1.13).

CONCLUSION

Prehospital epinephrine administration in patients with traumatic cardiac arrest was associated with increased survival to hospital discharge and prehospital ROSC. However, its association with favorable neurological outcomes remains uncertain. Further studies are required to clarify the optimal timing and patient selection for prehospital epinephrine administration.