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  • Anaphylaxis and Insect Stings and Bites

    Abstract Full Text
    JAMA. 2017; 318(1):86-87. doi: 10.1001/jama.2017.6470

    This Medical Letter review summarizes management of anaphylaxis and of insect bites and stings, including information about commercially available epinephrine auto-injectors for use by at-risk patients.

  • Epinephrine Auto-Injectors for Anaphylaxis

    Abstract Full Text
    JAMA. 2017; 317(3):313-313. doi: 10.1001/jama.2016.14505

    This Medical Letter review summarizes available generic and brand-name epinephrine auto-injectors in the wake of recent EpiPen price increases.

  • JAMA October 11, 2016

    Figure: Significant Increases in EpiPen Price

    As EpiPen prices soared, Congress has taken notice.
  • Significant Increases in EpiPen Price

    Abstract Full Text
    JAMA. 2016; 316(14):1439-1439. doi: 10.1001/jama.2016.14178
  • JAMA August 25, 2015

    Figure 1: Patient Flowchart for Study of Timing of Epinephrine and Pediatric In-Hospital Nonshockable Cardiac Arrest

    The database contained data on 15 959 pediatric in-hospital cardiac arrests. Of these, 1558 met all inclusion criteria and no exclusion criteria and were included in the analysis. ECMO indicates extracorporeal membrane oxygenation; ROSC, return of spontaneous circulation.
  • JAMA August 25, 2015

    Figure 2: Distribution of Time to Epinephrine in Pediatric In-Hospital Nonshockable Cardiac Arrest (N = 1558)

    The majority of the included patients received epinephrine early, with 37% receiving epinephrine within the first minute; 15% received the first dose of epinephrine more than 5 minutes after the cardiac arrest. (See Methods for definition of time to epinephrine.) No time point had zero observations.
  • JAMA August 25, 2015

    Figure 3: Time to Epinephrine and Survival to Hospital Discharge After Pediatric In-Hospital Nonshockable Cardiac Arrest (N = 1558)

    Longer time to epinephrine administration was associated with lower risk of survival to discharge in multivariable analysis (risk ratio per minute delay, 0.95 [95% CI, 0.93-0.98]; P < .001). Error bars indicate exact binomial 95% confidence intervals.
  • Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest

    Abstract Full Text
    free access
    JAMA. 2015; 314(8):802-810. doi: 10.1001/jama.2015.9678

    This study uses data for pediatric patients from the Get With the Guidelines–Resuscitation registry to report associations between delay in epinephrine and survival and neurological outcome after pediatric in-hospital cardiac arrest.

  • Pediatric Pulseless Arrest With “Nonshockable” Rhythm: Does Faster Time to Epinephrine Improve Outcome?

    Abstract Full Text
    JAMA. 2015; 314(8):776-777. doi: 10.1001/jama.2015.9527
  • Glucocorticoids for Acute Viral Bronchiolitis in Infants and Young Children

    Abstract Full Text
    JAMA. 2014; 311(1):87-88. doi: 10.1001/jama.2013.284921
  • JAMA January 1, 2014

    Figure: Hospitalizations in Outpatients (Days 1 and 7) for Glucocorticoids vs Placebo

    Source: Data have been adapted with permission from the Cochrane Collaboration. The relative risk was calculated using the Mantel-Haenszel random effect method. Kuyucu and Plint (both factorial trials) and Barlas (parallel multi-group trial) contribute 2 independent comparisons, which are shown separately. The size of the data markers indicate the weight assigned to each study in the meta-analysis. G indicates glucocorticoid; S, salbutamol; E, epinephrine; P, placebo.
  • Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest: A Randomized Clinical Trial

    Abstract Full Text
    free access
    JAMA. 2013; 310(3):270-279. doi: 10.1001/jama.2013.7832

    Mentzelopoulos and coauthors conducted a randomized clinical trial among 268 patients to investigate survival to hospital discharge with favorable neurological status after treatment with combined vasopressin-epinephrine and methylprednisolone during cardiopulmonary resuscitation and stress-dose hydrocortisone in postresuscitation shock.

  • JAMA July 17, 2013

    Figure 2: Results on Survival Analysis

    Probability of survival with a Cerebral Performance Category (CPC) score of 1 or 2 to day 60 after randomization, which was identical to survival to hospital discharge with a CPC score of 1 or 2, in all 268 patients (A) and in the 149 patients with postresuscitation shock (B). The numbers of patients at risk were reduced according to the time points of occurrence of patient death or the earliest follow-up neurological evaluation that was consistent with a subsequent, poor neurological outcome (ie, CPC score of ≥3) that was ultimately confirmed at the final neurological evaluation at hospital discharge. VSE indicates vasopressin-steroids-epinephrine.
  • JAMA July 17, 2013

    Figure 1: Study Flowchart

    For brevity, “Died” corresponds to poor outcome as defined in the “Methods” section. VF/VT indicates ventricular fibrillation/ventricular tachycardia; DC, direct current; ROSC, return of spontaneous circulation.aWithin 4 hours of ROSC, 15 patients in the control group and 23 patients in the vasopressin-steroids-epinephrine (VSE) group experienced vasopressor-unresponsive hypotension (ie, treatment-refractory shock) and died.bIn the control group, all 3 patients were alive on days 1 and 10, and 1 patient was alive at hospital discharge with a Cerebral Performance Category (CPC) score of 1 or 2. In the VSE group, all 10 patients were alive on day 1, 6 patients were alive on day 10, and 2 patients were alive at hospital discharge with a CPC score of 1 or 2.cThirteen patients of the VSE group also received open-label hydrocortisone.dThis was done according to attending physician decision. According to the study protocol, control patients should receive saline placebo and VSE patients hydrocortisone; on day 10 placebo or hydrocortisone should be discontinued in both groups.eIn the control group, 6 survivors originated from the postresuscitation shock subgroup; in the VSE group, 16 survivors originated from the postresuscitation shock subgroup.fIn post hoc analysis (see also the online Supplement), 5 controls and 11 VSE patients achieved 1-year survival with a CPC score of 1 or 2.
  • JAMA January 16, 2013

    Figure 2: Results of Conditional Logistic Regression Models Using One of the End Points as a Dependent Variable With Propensity-Matched Patients

    Full models for the primary outcome analysis are included in eTable 2. aFor all odds ratios, P < .001. bSelected variables are a predefined set of potential confounders including age, sex, cause of cardiac arrest, first documented rhythm, bystander witness, type of cardiopulmonary resuscitation (CPR) initiated by a bystander, use of public access automated external defibrillator by bystander, epinephrine administration, time from receipt of call to CPR by emergency medical service, and time from receipt of call to hospital arrival. cAll variables included all covariates in Table 1 and variables for 47 prefectures in Japan.
  • JAMA March 21, 2012

    Figure 2: Results of Unconditional Logistic Regression Analyses Comparing Prehospital Epinephrine Use vs No Prehospital Epinephrine Use in Patients With Out-of-Hospital Cardiac Arrest

    CPC indicates Cerebral Performance Category; OPC, Overall Performance Category; ROSC, return of spontaneous circulation. Different sample sizes in the 3 models result from increasing numbers of cases with missing data as the number of independent variables increased. aSelected variables included age, sex, bystander eyewitness, relationship of bystander to patient, bystander chest compression, bystander rescue breathing, use of public-access automated external defibrillator by bystander, first documented rhythm, and time from call to arrival at the scene for the model with ROSC as a dependent variable. For other models, ROSC and the above selected variables were adjusted. bAll covariates included all variables in Table 1 plus 46 dummy variables for the 47 prefectures in Japan for the model with ROSC as a dependent variable. For other models, ROSC, all variables in Table 1, and 46 dummy variables for the 47 prefectures in Japan were adjusted.
  • JAMA March 21, 2012

    Figure 3: Results of Conditional Logistic Regression Analyses Comparing Prehospital Epinephrine Use vs No Prehospital Epinephrine Use in Propensity-Matched Patients With Out-of-Hospital Cardiac Arrest

    CPC indicates Cerebral Performance Category; OPC, Overall Performance Category; ROSC, return of spontaneous circulation. aSelected variables included age, sex, bystander eyewitness, relationship of bystander to patient, bystander chest compression, bystander rescue breathing, use of public-access automated external defibrillator by bystander, first documented rhythm, and time from call to arrival at the scene for the model with ROSC as a dependent variable. For other models, ROSC and the above selected variables were adjusted. bAll covariates included all variables in Table 1 plus 46 dummy variables for the 47 prefectures in Japan for the model with ROSC as a dependent variable. For other models, ROSC, all variables in Table 1, and 46 dummy variables for the 47 prefectures in Japan were adjusted.
  • Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest

    Abstract Full Text
    free access
    JAMA. 2012; 307(11):1161-1168. doi: 10.1001/jama.2012.294
  • Questioning the Use of Epinephrine to Treat Cardiac Arrest

    Abstract Full Text
    JAMA. 2012; 307(11):1198-1200. doi: 10.1001/jama.2012.313
  • Treating Snakebites

    Abstract Full Text
    JAMA. 2011; 305(23):2402-2402. doi: 10.1001/jama.2011.833