Effect of initial airway strategy on time to epinephrine administration in patients with out-of-hospital cardiac arrest

Abstract

Introduction: Epinephrine and advanced airway management are commonly used during treatment of out-of-hospital cardiac arrest (OHCA). Recent studies suggest that early but not late administration of epinephrine is associated with improved survival. The purpose of this study was to evaluate the effect of initial airway strategy on timing to the first epinephrine dose in OHCA. Methods: This is a secondary analysis of patients enrolled in the Pragmatic Airway Resuscitation Trial who had an advanced airway attempted. We examined differences in time to epinephrine administration by randomly assigned airway strategy, laryngeal tube (LT) or endotracheal tube (ETI); by the duration of airway attempt; and by number of attempts. We used survival methods to account for interval censoring due to unknown administration time. We also examined the association of epinephrine administration timing with survival to hospital discharge. Results: Among 2652 subjects (1299 ETI and 1353 LT), 2579 received epinephrine. There were no significant differences between ETI and LT in median time to initial epinephrine administration (min) (ETI-9.0 vs. LT-8.6, p=0.55). There was no significant association between the duration of airway attempt or number of attempts and time to initial epinephrine administration (p=0.12 and 0.66, respectively). Early administration of epinephrine (<10 minutes from EMS arrival) was significantly associated with survival compared to administration ≥10 minutes (OR 1.36, 95% CI: 1.05, 1.77). Conclusions: There was no significant association between airway strategy and time to initial epinephrine administration. Earlier administration of epinephrine (< 10 minutes from EMS arrival) was associated with improved survival.

Outcomes of Early versus Late Endotracheal Intubation in Patients with Initial Non-Shockable Rhythm Cardiopulmonary Arrest in the Emergency Department

“…Izawa et al [ 9 ] demonstrated that in their early AAM group, their patients also received early epinephrine administration. In contrast, Lupton et al [ 13 ] did not find an association between AAM and time to initial epinephrine administration in out-of-hospital cardiac arrest. This finding might be explained by the effect of high performance of the CPR team; with more effective resuscitation, epinephrine can be administered immediately, and the advanced airway can be also placed early.…”

Optimal duration and timing of basic-life-support-only intervention for patients with out-of-hospital cardiac arrest

“…For adult patients in cardiac arrest, epinephrine administration in the early stage and after the third shock is recommended for non-shockable and shockable rhythms, respectively 4 . Another study showed that administering epinephrine within 10 min after scene arrival was associated with improved survival among patients with OHCA 5 . However, the required intravenous access and other advanced interventions may negatively impact the quality of chest compressions 6 .…”

Optimal Duration and Timing of Basic-life-support-Only Intervention for Patients with Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study in Japan

“…For adult patients in cardiac arrest, adrenaline administration in the early stage and after the third shock is recommended for non-shockable and shockable rhythms, respectively [4]. Another study showed that administering adrenaline within 10 min after scene arrival was associated with improved survival among patients with in OHCA [5]. However, the required intravenous access and other advanced interventions may negatively impact the quality of chest compressions [6].…”