The Use of Epinephrine for Out-of-Hospital Treatment of Anaphylaxis: Resource Document for the National Association of EMS Physicians Position Statement

Jacobsen, Ryan C.; Millin, Michael G.

doi:10.3109/10903127.2011.598619

Cited by 15 publications

(3 citation statements)

References 40 publications

(49 reference statements)

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“…The access to epinephrine auto-injectors is vitally important in public settings, such as restaurants, daycares, schools, and workplaces. 34 Policymakers should be made aware of the risks of anaphylaxis in various age groups and the effectiveness of epinephrine for the management of acute anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Trends, characteristics, and incidence of anaphylaxis in 2001-2010: A population-based study

Lee

Hess

Lohse

et al. 2017

Journal of Allergy and Clinical Immunology

121

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Section: Discussionmentioning

confidence: 99%

Trends, characteristics, and incidence of anaphylaxis in 2001-2010: A population-based study

Lee

Hess

Lohse

et al. 2017

Journal of Allergy and Clinical Immunology

121

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“…Lastly, although protocols at the time of the patient encounter clearly delineate the proper medications to administer in anaphylaxis, it is important to note that the National Association of EMS Physicians Position Statement on the use of epinephrine in out-of-hospital anaphylaxis was published in the last few months of this study's timeframe. 22 It is unclear if rates of epinephrine administration have improved after allowing for the dissemination of the position paper throughout the EMS systems in these two counties.…”

Section: Limitationsmentioning

confidence: 99%

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Carrillo¹,

Hern²,

Barger³

2015

Prehospital Emergency Care

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Anaphylaxis in the pediatric population is both serious and potentially lethal. The incidence of allergic and anaphylactic reactions has been increasing and the need for life saving intervention with epinephrine must remain an important part of Emergency Medical Services (EMS) provider training. Our aim was to characterize dosing and timing of epinephrine, diphenhydramine, and albuterol in the pediatric patient with anaphylaxis. In this retrospective chart review, we studied prehospital medication administration in pediatric patients ages 1 month up to 14 years old classified as having a severe allergic reaction or anaphylaxis. We compared rates of epinephrine, diphenhydramine, and albuterol given to patients with allergic conditions including anaphylaxis. In addition, we calculated the rate of epinephrine administration in cases of anaphylaxis and determined what percentage of time the epinephrine was given by EMS or prior to their arrival. Of the pediatric patient contacts, 205 were treated for allergic complaints. Of those with allergic complaints, 98 of 205 (48%; 95% CI 41%, 55%) had symptoms consistent with anaphylaxis and indications for epinephrine. Of these 98, 53 (54%, 95% CI 44%, 64%) were given epinephrine by EMS or prior to EMS arrival. Among the patients in anaphylaxis not given epinephrine prior to EMS arrival, 6 (12%; 95% CI 3%, 21%) received epinephrine from EMS, 10 (20%; 95% CI 9%, 30%) received diphenhydramine only, 9 (18%, 95% CI 7%-28%) received only albuterol and 17 (33%, 95% CI 20%-46%) received both albuterol and diphenhydramine. 9 patients in anaphylaxis received no treatment prior to arriving to the emergency department (18%, 95% CI 7%-28%). In pediatric patients who met criteria for anaphylaxis and the use of epinephrine, only 54% received epinephrine and the overwhelming majority received it prior to EMS arrival. EMS personnel may not be treating anaphylaxis appropriately with epinephrine.

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“…Anaphylaxis is a potentially life-threatening allergic reaction. Because anaphylaxis can rapidly become fatal, avoiding the allergen and obtaining early treatment are critical for preventing fatal outcomes [ 1 – 3 ]. Guidelines universally recommend that patients who have had an anaphylactic reaction should avoid an allergen and carry an epinephrine auto-injector (known as an epi-pen) [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and outcomes of anaphylaxis-associated out-of-hospital cardiac arrest

Lee

Shin

et al. 2018

PLoS ONE

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BackgroundUnderstanding the epidemiological characteristics of anaphylaxis-associated out-of-hospital cardiac arrest (OHCA) is the first step toward developing preventative strategies and optimizing care systems. We aimed to describe and compare epidemiological features and clinical outcomes among patients with anaphylaxis-associated OHCAs according to causative agent groups.MethodsWe identified emergency medical service (EMS)-treated anaphylaxis-associated OHCA patients from a nationwide OHCA registry between 2008 and 2015. We compared epidemiological characteristics and outcomes according to causal agents (a natural agents group and an iatrogenic agents group) and evaluated temporal variability in incidence. Multivariate logistic regression analysis was performed to compare survival to discharge between causative agent groups.ResultsDuring the study period (8 years), the total number of anaphylaxis-associated OHCAs was 233. A total of 224 eligible cases were included in the analysis. There were 192 patients (85.6%) in the natural agents group and 32 patients (14.3%) in the iatrogenic agents group. There was significant diurnal and seasonal variability in the frequency of anaphylaxis-associated OHCAs (p values<0.01 for both), with the highest incidences occurring during the day (7:01 am to 3 pm; 64.6%) and in summer (June to August, 48.7%). Compared with the natural agents group, the adjusted odds ratio (AOR) for survival to discharge in the iatrogenic agents group was statistically insignificant (AOR 3.61, 95% CI 0.86 to 15.06).ConclusionThe incidence of anaphylaxis-associated OHCA is considerably low, and significant temporal variability, with a peak during the day and in summer, is evident. Anaphylaxis-associated OHCA is more common by natural agents than by iatrogenic agents, but no difference in the survival-to-discharge rate is evident.

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The Use of Epinephrine for Out-of-Hospital Treatment of Anaphylaxis: Resource Document for the National Association of EMS Physicians Position Statement

Cited by 15 publications

References 40 publications

Trends, characteristics, and incidence of anaphylaxis in 2001-2010: A population-based study

Trends, characteristics, and incidence of anaphylaxis in 2001-2010: A population-based study

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Epidemiology and outcomes of anaphylaxis-associated out-of-hospital cardiac arrest

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