Abstract：
OBJECTIVE: To assess whether initial epinephrine administration by endotracheal tube (ET) in newly born infants receiving chest compressions and epinephrine in the delivery room (DR) is associated with lower rates of return of spontaneous circulation (ROSC) than newborns receiving initial intravenous (IV) epinephrine.
METHODS: We conducted a retrospective review of neonates receiving chest compressions and epinephrine in the DR from the AHA Get With The Guidelines-Resuscitation registry from October 2013 through July 2020. Neonates were classified according to initial route of epinephrine (ET vs IV). The primary outcome of interest was ROSC in the DR.
RESULTS: In total, 408 infants met inclusion criteria; of these, 281 (68.9%) received initial ET epinephrine and 127 (31.1%) received initial IV epinephrine. The initial ET epinephrine group included those infants who also received subsequent IV epinephrine when ET epinephrine failed to achieve ROSC. Comparing initial ET with initial IV epinephrine, ROSC was achieved in 70.1% vs 58.3% (adjusted risk difference 10.02; 95% CI 0.05-19.99). ROSC was achieved in 58.3% with IV epinephrine alone, and 47.0% with ET epinephrine alone, with 40.0% receiving subsequent IV epinephrine.
CONCLUSIONS: This study suggests that initial use of ET epinephrine is reasonable during DR resuscitation, as there were greater rates of ROSC compared with initial IV epinephrine administration. However, administration of IV epinephrine should not be delayed in those infants not responding to initial ET epinephrine, as almost one-half of infants who received initial ET epinephrine subsequently received IV epinephrine before achieving ROSC.
METHODS: We conducted a retrospective review of neonates receiving chest compressions and epinephrine in the DR from the AHA Get With The Guidelines-Resuscitation registry from October 2013 through July 2020. Neonates were classified according to initial route of epinephrine (ET vs IV). The primary outcome of interest was ROSC in the DR.
RESULTS: In total, 408 infants met inclusion criteria; of these, 281 (68.9%) received initial ET epinephrine and 127 (31.1%) received initial IV epinephrine. The initial ET epinephrine group included those infants who also received subsequent IV epinephrine when ET epinephrine failed to achieve ROSC. Comparing initial ET with initial IV epinephrine, ROSC was achieved in 70.1% vs 58.3% (adjusted risk difference 10.02; 95% CI 0.05-19.99). ROSC was achieved in 58.3% with IV epinephrine alone, and 47.0% with ET epinephrine alone, with 40.0% receiving subsequent IV epinephrine.
CONCLUSIONS: This study suggests that initial use of ET epinephrine is reasonable during DR resuscitation, as there were greater rates of ROSC compared with initial IV epinephrine administration. However, administration of IV epinephrine should not be delayed in those infants not responding to initial ET epinephrine, as almost one-half of infants who received initial ET epinephrine subsequently received IV epinephrine before achieving ROSC.
摘要：
目的：评估在分娩室接受胸部按压和肾上腺素的新生婴儿中，最初通过气管导管（ET）给予肾上腺素是否与最初接受静脉（IV）肾上腺素的新生儿相比，具有较低的自主循环恢复率（ROSC）。
方法：我们对2013年10月至2020年7月在AHAGetWithTheGuidelines®-Resuscitation登记处接受胸部按压和肾上腺素的新生儿进行了回顾性研究。根据肾上腺素的初始途径（ET与IV）对新生儿进行分类。感兴趣的主要结果是DR中的ROSC。
结果：408名婴儿符合纳入标准；其中，281（68.9％）接受了初始ET肾上腺素，127（31.1％）接受了初始IV肾上腺素。最初的ET肾上腺素组包括那些在ET肾上腺素未能达到ROSC时也接受了随后的IV肾上腺素的婴儿。比较初始ET和初始静脉注射肾上腺素，ROSC在70.1%与58.3%（调整后风险差异（aRD）=10.02，[95%CI0.05，19.99]）。单独使用静脉注射肾上腺素的ROSC达到58.3％，47.0%单独使用ET肾上腺素，40.0%随后接受IV肾上腺素。
结论：这项研究表明，在DR复苏期间，最初使用ET肾上腺素是合理的，因为与最初的静脉注射肾上腺素相比，ROSC的发生率更高。然而,对于那些对初始ET肾上腺素无反应的婴儿，不应延迟静脉注射肾上腺素，因为几乎一半接受ET肾上腺素治疗的婴儿随后在实现ROSC之前接受了IV肾上腺素治疗。
方法：我们对2013年10月至2020年7月在AHAGetWithTheGuidelines®-Resuscitation登记处接受胸部按压和肾上腺素的新生儿进行了回顾性研究。根据肾上腺素的初始途径（ET与IV）对新生儿进行分类。感兴趣的主要结果是DR中的ROSC。
结果：408名婴儿符合纳入标准；其中，281（68.9％）接受了初始ET肾上腺素，127（31.1％）接受了初始IV肾上腺素。最初的ET肾上腺素组包括那些在ET肾上腺素未能达到ROSC时也接受了随后的IV肾上腺素的婴儿。比较初始ET和初始静脉注射肾上腺素，ROSC在70.1%与58.3%（调整后风险差异（aRD）=10.02，[95%CI0.05，19.99]）。单独使用静脉注射肾上腺素的ROSC达到58.3％，47.0%单独使用ET肾上腺素，40.0%随后接受IV肾上腺素。
结论：这项研究表明，在DR复苏期间，最初使用ET肾上腺素是合理的，因为与最初的静脉注射肾上腺素相比，ROSC的发生率更高。然而,对于那些对初始ET肾上腺素无反应的婴儿，不应延迟静脉注射肾上腺素，因为几乎一半接受ET肾上腺素治疗的婴儿随后在实现ROSC之前接受了IV肾上腺素治疗。
