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

RESUSCITATION

卷:139

Article

Lupton, Joshua R.¹  Schmicker, Robert²  Daya, Mohamud R.¹  Aufderheide, Tom P.³  Stephens, Shannon⁴  Le, Nancy¹  May, Susanne²  Puyana, Juan Carlos⁵  Idris, Ahamed⁶  Nichol, Graham²  Wang, Henry⁷  Hansen, Matt¹ 

[1] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[2] Univ Washington, Seattle, WA 98195 USA

[3] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[4] Univ Alabama Birmingham, Birmingham, AL USA

[5] Univ Pittsburgh, Pittsburgh, PA 15260 USA

[6] Univ Texas Southwestern, Dallas, TX USA

[7] Univ Texas Hlth Sci Ctr Houston, Houston, TX 77030 USA

关键词: Out-of-hospital cardiac arrest;    Epinephrine;    Airway management;    Supraglottic;    Endotracheal;   

DOI  :  10.1016/j.resuscitation.2019.03.015

来源: Elsevier

【 摘 要 】

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 min from EMS arrival) was significantly associated with survival compared to administration >= 10 min (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 min from EMS arrival) was associated with improved survival.

【 授权许可】

Free