The elucidation of the RAA system in the cardiopulmonary arrest state to establish the new method of vasopressor administration

2021 Fiscal Year Final Research Report

• Project/Area Number: 18K08908
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Gunma University
• Principal Investigator: Oshima Kiyohiro 群馬大学, 大学院医学系研究科, 教授 (60361375)
• Co-Investigator(Kenkyū-buntansha): 萩原 周一 群馬大学, 大学院医学系研究科, 講師 (20455992) ; 澤田 悠輔 群馬大学, 医学部附属病院, 医員 (90805897)
• Project Period (FY): 2018-04-01 – 2022-03-31
• Keywords: 心肺蘇生 / 心肺停止 / アドレナリン

Outline of Final Research Achievements

Patients with OHCA transferred to our hospital between July 2014 and July 2017 were analyzed. The plasma levels of catecholamines were measured using blood samples obtained immediately upon arrival at the hospital and before the administration of adrenaline (Ad). Patients were divided into 3 groups based on the prehospital administered dosage of Ad: no prehospital administration (group Z, n=96); 1 mg of Ad (group O, n=38); and 2 mg of Ad (group T, n=11). Group T exhibited the highest plasma levels of Ad with a statistically significant difference, however, there were no significant difference in the rate of ROSC among the 3 groups. In addition, patients in group Z were divided into 2 groups: ROSC(+)(n=34) and ROSC(-)(n=62) groups. The plasma levels of Ad and noradrenaline were significantly lower in the ROSC(+) group.
Tanking those results into considerations, increased levels of Ad in the plasma may not be associated with the acquisition of ROSC in patients with OHCA.

Free Research Field

救急医学

Academic Significance and Societal Importance of the Research Achievements

2021年6月に発行された日本蘇生協議会「蘇生ガイドライン2020」において、「心肺蘇生中にアドレナリンを投与することを推奨する（強い推奨、エビデンスの確実性：低い、Grade 1C）」と記されているが、一方で「心肺停止症例へのアドレナリン投与に関する神経学的転帰への影響は不確実なまま」とも記載され、その臨床的意義に関してはいまだcontroversialである。
本研究結果は、心肺停止症例での血中アドレナリン濃度上昇が直ちにROSC獲得に関連しない可能性を示唆しており、今後の心肺蘇生における血管収縮薬確立に大きく寄与する内容であり、その学術的および社会的意義は極めて大きいと考える。