Epinephrine and norepinephrine are the two most commonly used prehospital vasopressors in the United States. Prior studies have suggested that use of a post-ROSC epinephrine infusion may be associated with increased rearrest and mortality in comparison to use of norepinephrine. We used target trial emulation methodology to compare the rates of rearrest and mortality between the groups of OHCA patients receiving these vasopressors in the prehospital setting. Adult (18–80 years of age) non-traumatic OHCA patients in the 2018–2022 ESO Data Collaborative datasets with a documented post-ROSC norepinephrine or epinephrine infusion were included in this study. Logistic regression modeling was used to evaluate the association between vasopressor agent and outcome using two sets of covariables. The first set of covariables included standard Utstein factors, the dispatch to ROSC interval, the ROSC to vasopressor interval, and the follow-up interval. The second set added prehospital systolic blood pressure and SpO values. Kaplan-Meier time-to-event analysis was also conducted and the vasopressor groups were compared using a multivariable Cox regression model. Overall, 1,893 patients treated by 309 EMS agencies were eligible for analysis. 1,010 (53.4%) received an epinephrine infusion and 883 (46.7%) received a norepinephrine infusion as their initial vasopressor. Adjusted analyses did not discover an association between vasopressor agent and rearrest (aOR: 0.93 [0.72, 1.21]) or mortality (aOR: 1.00 [0.59, 1.69]). In this multi-agency target trial emulation, the use of a post-resuscitation epinephrine infusion was not associated with increased odds of rearrest in comparison to the use of a norepinephrine infusion.

中文翻译：

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用于比较复苏后肾上腺素与去甲肾上腺素的回顾性、多机构“目标试验模拟”

肾上腺素和去甲肾上腺素是美国两种最常用的院前升压药。先前的研究表明，与使用去甲肾上腺素相比，使用ROSC后输注肾上腺素可能会增加再逮捕和死亡率。我们使用目标试验模拟方法来比较在院前接受这些血管加压药的 OHCA 患者组之间的再逮捕率和死亡率。本研究纳入了 2018-2022 年 ESO 数据协作数据集中的成人（18-80 岁）非创伤性 OHCA 患者，并记录了 ROSC 后去甲肾上腺素或肾上腺素输注的情况。使用逻辑回归模型通过两组协变量来评估血管加压剂与结果之间的关联。第一组协变量包括标准 Utstein 因子、调度至 ROSC 间隔、ROSC 至血管加压药间隔以及随访间隔。第二组添加了院前收缩压和 SpO 值。还进行了 Kaplan-Meier 事件发生时间分析，并使用多变量 Cox 回归模型对血管加压药组进行了比较。总体而言，309 个 EMS 机构治疗的 1,893 名患者符合分析资格。 1,010 人 (53.4%) 接受了肾上腺素输注，883 人 (46.7%) 接受了去甲肾上腺素输注作为初始血管加压药。调整后的分析未发现升压药与再次休息（aOR：0.93 [0.72，1.21]）或死亡率（aOR：1.00 [0.59，1.69]）之间存在关联。在这项多机构目标模拟试验中，与使用去甲肾上腺素输注相比，使用复苏后输注肾上腺素与再逮捕的几率增加无关。