來源：醫學英語讀讀吧 作者：NEJM
【A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest
院外心臟驟停使用腎上腺素的隨機試驗】
Epinephrine n.腎上腺素
Resuscitation n.復甦
Paramedic n.救護人員
Parenteral adj.注射用藥的
Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebo-controlled trial to determine whether the use of epinephrine is safe and effective in such patients. In the PARAMEDIC2 trial involving 8014 patients with out-of-hospital cardiac arrest in the United Kingdom, paramedics at five National Health Service ambulance services administered either parenteral epinephrine or saline placebo, along with standard care. The primary outcome was the rate of survival at 30 days. At 30 days, 3.2% patients in the epinephrine group and 2.4% in the placebo group were alive. There was no evidence of a significant difference in the proportion of patients who survived until hospital discharge with a favorable neurologic outcome (2.2% patients vs. 1.9% patients). At the time of hospital discharge, severe neurologic impairment (a score of 4 or 5 on the modified Rankin scale) had occurred in more of the survivors in the epinephrine group than in the placebo group (31.0% patients vs.17.8% patients). In adults with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine group.1
【譯文】對使用腎上腺素治療院外心臟驟停的擔憂，使得國際復甦聯絡委員會要求進行安慰劑對照試驗，以確定對這類患者使用腎上腺素是否安全有效。在英國，包括8014名院外心臟驟停患者的PARAMEDIC2試驗中，五個國家衛生服務救護車的救護人員給予這些患者腎上腺素或者生理鹽水安慰劑注射以及標準治療。主要臨床結局是30天存活率。30天時，腎上腺素組中3.2％的患者以及安慰劑組中的2.4％患者存活。沒有證據顯示，兩組到出院時存活並且神經系統結局良好的患者比例存在顯著差異（2.2％患者對1.9％患者）。出院時，相比安慰劑組，腎上腺素組有更多的倖存者發生嚴重的神經損傷（改良的Rankin量表評分為4或5）（31.0％患者比17.8％患者）。在院外心臟驟停的成人中，使用腎上腺素導致30天生存率顯著高於使用安慰劑。但是，在良好的神經系統結局上，兩組間無顯著差異，因為在腎上腺素組有更多的倖存者出現嚴重神經功能障礙。
【醫學單詞記憶之道】
1. 常用醫學詞組
out-of-hospital 院前
cardiac arrest 心臟驟停
心臟驟停SCA
【醫學英語延伸閱讀】
The administration of epinephrine has been part of the resuscitation of patients with cardiac arrest since the 1960s. However, epinephrine decreases microvascular blood flow in some organs, increases cardiac dysrhythmias, and increases myocardial oxygen demand during critical ischemia. These deleterious effects can result in long-term organ dysfunction or hypoperfusion of the heart and brain. These deleterious effects can result in long-term organ dysfunction or hypoperfusion of the heart and brain. Despite decades of epinephrine use, data on the benefit of the drug comes primarily from conflicting observational studies with a high risk of bias.
The PARAMEDIC2 trial provides the largest set of randomized data on epinephrine use in out-of-hospital cardiac arrest so far. Patients who received epinephrine had a higher rate of 30-day survival than those who received placebo, but the overall survival rate in this trial was disappointingly small. Epinephrine robustly improved a return of spontaneous circulation.
Despite having a powerful effect on restoring spontaneous circulation after out-of-hospital cardiac arrest, epinephrine produced only a small absolute increase in survival with no increase in favorable functional recovery as compared with placebo. We now must ponder whether additional treatments after a return of spontaneous circulation could improve functional recovery, whether drug use should differ on the basis of cardiac rhythm, and whether lower doses of epinephrine would be superior to higher doses among patients with out-of-hospital cardiac arrest.2
參考文獻
1. Gavin D. Perkins, Chen Ji, and et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med 2018; 379:711-721.
2. Clifton W. Callaway and Michael W. Donnino. Testing Epinephrine for Out-of-Hospital Cardiac Arrest. N Engl J Med 2018; 379:787-788.
溫馨提示：本平臺已開通文章搜索功能，可關注後發送關鍵詞體驗。
歡迎您在下方留言↓↓↓