{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T03:08:05Z","timestamp":1761102485357,"version":"3.37.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"JAAM and a scientific research grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan","award":["16K09034 and 15H05006"],"award-info":[{"award-number":["16K09034 and 15H05006"]}]},{"name":"Ministry of Health, Labour, and Welfare of Japan","award":["25112601"],"award-info":[{"award-number":["25112601"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The delayed administration of epinephrine has been proven to worsen the neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA) and shockable rhythm or asystole. We aimed to investigate whether the delayed administration of epinephrine might also worsen the neurological outcomes of patients with witnessed OHCA and initial pulseless electrical activity (PEA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>The JAAM-OHCA Registry is a multicentre registry including OHCA patients between 2014 and 2017. Patients with emergency medical services (EMS)-treated OHCA and initial PEA rhythm were included. The primary exposure was the time from the EMS call to the administration of epinephrine. The secondary exposure was the time to epinephrine dichotomized as early (\u226415 min) or delayed (&amp;gt;15 min). The primary outcome was the achievement of a favourable neurological outcome, defined as Cerebral Performance Categories Scale 1\u20132 at 30 days after OHCA. Out of 34\u200a754 patients with OHCA, 3050 patients were included in the present study. After adjusting for potential confounders, the delayed administration of the epinephrine was associated with a lower likelihood of achieving a favourable neurological outcome [adjusted odds ratio (OR) 0.96; 95% confidence interval (CI) 0.93\u20130.99; P = 0.016]. The percentage of patients who achieved a favourable neurological outcome in the delayed epinephrine group was lower than that in the early epinephrine group (1.3% vs. 4.7%; adjusted OR 0.33; 95% CI 0.15\u20130.72; P = 0.005). A restricted cubic spline analysis demonstrated that delayed epinephrine administration could decrease the likelihood of achieving a favourable neurological outcome; this was significant within the first 10 min.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The delayed administration of epinephrine was associated with worse neurological outcomes in patients with witnessed OHCA patients with initial PEA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuac026","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T12:14:00Z","timestamp":1645445640000},"page":"389-396","source":"Crossref","is-referenced-by-count":5,"title":["Delayed administration of epinephrine is associated with worse neurological outcomes in patients with out-of-hospital cardiac arrest and initial pulseless electrical activity: insight from the nationwide multicentre observational JAAM-OHCA (Japan Association for Acute Medicine) registry"],"prefix":"10.1093","volume":"11","author":[{"given":"Nobuyuki","family":"Enzan","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0813-4428","authenticated-orcid":false,"given":"Ken ichi","family":"Hiasa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5734-335X","authenticated-orcid":false,"given":"Kenzo","family":"Ichimura","sequence":"additional","affiliation":[{"name":"School of Medicine, Pulmonary, Allergy and Critical Care Medicine, Stanford University , 300 Pasteur Drive, Grand Bld Rm S126B , Stanford, CA 94305 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaaki","family":"Nishihara","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Center, Kyushu University Hospital , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Iyonaga","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Center, Kyushu University Hospital , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Shono","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Center, Kyushu University Hospital , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Tohyama","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Research, Kyushu University Hospital , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kouta","family":"Funakoshi","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Research, Kyushu University Hospital , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9006-5937","authenticated-orcid":false,"given":"Takanari","family":"Kitazono","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care Center, Kyushu University Hospital , 3-1-1 Maidashi, Higashi-ku , Fukuoka 812-8582, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Tsutsui","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University , 3-1-1 Maidashi, Higashi-ku , Fukuoka 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