Prehospital lactated ringer's solution treatment and survival in out-of-hospital cardiac arrest: a prospective cohort analysis

• Published in: PLoS medicine 2013-02, Vol.10 (2), p.e1001394
• Main Authors: Hagihara, Akihito, Hasegawa, Manabu, Abe, Takeru, Wakata, Yoshifumi, Nagata, Takashi, Nabeshima, Yoshihiro
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiac arrest; Cardiopulmonary resuscitation; Care and treatment; Case-Control Studies; Chi-Square Distribution; CPR; Emergency Medical Services - methods; Female; Fluid Therapy - adverse effects; Fluid Therapy - mortality; Heart attacks; Hospitals; Humans; Infusions, Intravenous; Isotonic Solutions - administration & dosage; Isotonic Solutions - adverse effects; Japan; Logistic Models; Male; Medical research; Medicine; Middle Aged; Multivariate Analysis; Odds Ratio; Out-of-Hospital Cardiac Arrest - diagnosis; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Propensity Score; Prospective Studies; Registries; Risk Assessment; Risk Factors; Services; Social medicine; Studies; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1001394

No studies have evaluated whether administering intravenous lactated Ringer's (LR) solution to patients with out-of-hospital cardiac arrest (OHCA) improves their outcomes, to our knowledge. Therefore, we examined the association between prehospital use of LR solution and patients' return of spontaneous circulation (ROSC), 1-month survival, and neurological or physical outcomes at 1 month after the event. We conducted a prospective, non-randomized, observational study using national data of all patients with OHCA from 2005 through 2009 in Japan. We performed a propensity analysis and examined the association between prehospital use of LR solution and short- and long-term survival. The study patients were ≥18 years of age, had an OHCA before arrival of EMS personnel, were treated by EMS personnel, and were then transported to hospitals. A total of 531,854 patients with OHCA met the inclusion criteria. Among propensity-matched patients, compared with those who did not receive pre-hospital intravenous fluids, prehospital use of LR solution was associated with an increased likelihood of ROSC before hospital arrival (odds ratio [OR] adjusted for all covariates [95% CI] = 1.239 [1.146-1.339] [p