Joshua R Lupton1, Robert Schmicker2, Mohamud R Daya3, Tom P Aufderheide4, Shannon Stephens5, Nancy Le6, Susanne May7, Juan Carlos Puyana8, Ahamed Idris9, Graham Nichol10, Henry Wang11, Matt Hansen12. 1. Oregon Health and Science University United States. Electronic address: lupton@ohsu.edu. 2. University of Washington United States. Electronic address: rschmick@uw.edu. 3. Oregon Health and Science University United States. Electronic address: dayam@ohsu.edu. 4. Medical College of Wisconsin United States. Electronic address: taufderh@mcw.edu. 5. University of Alabama at Birmingham United States. Electronic address: swstephens@uabmc.edu. 6. Oregon Health and Science University United States. Electronic address: lena@ohsu.edu. 7. University of Washington United States. Electronic address: sjmay@uw.edu. 8. University of Pittsburgh United States. Electronic address: puyanajj@upmc.edu. 9. University of Texas Southwestern United States. Electronic address: aidris@sbcglobal.net. 10. University of Washington United States. Electronic address: nichol@uw.edu. 11. University of Texas Health Science Center United States. Electronic address: henry.e.wang@uth.tmc.edu. 12. Oregon Health and Science University United States. Electronic address: hansemat@ohsu.edu.
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 receivedepinephrine.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.
RCT Entities:
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.
Authors: Mark S Link; Lauren C Berkow; Peter J Kudenchuk; Henry R Halperin; Erik P Hess; Vivek K Moitra; Robert W Neumar; Brian J O'Neil; James H Paxton; Scott M Silvers; Roger D White; Demetris Yannopoulos; Michael W Donnino Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: Matthew Hansen; Robert H Schmicker; Craig D Newgard; Brian Grunau; Frank Scheuermeyer; Sheldon Cheskes; Veer Vithalani; Fuad Alnaji; Thomas Rea; Ahamed H Idris; Heather Herren; Jamie Hutchison; Mike Austin; Debra Egan; Mohamud Daya Journal: Circulation Date: 2018-03-06 Impact factor: 29.690
Authors: Janice A Tijssen; David K Prince; Laurie J Morrison; Dianne L Atkins; Michael A Austin; Robert Berg; Siobhan P Brown; Jim Christenson; Debra Egan; Preston J Fedor; Ericka L Fink; Garth D Meckler; Martin H Osmond; Kathryn A Sims; James S Hutchison Journal: Resuscitation Date: 2015-06-19 Impact factor: 5.262
Authors: C Koscik; A Pinawin; H McGovern; D Allen; D E Media; T Ferguson; W Hopkins; K N Sawyer; J Boura; R Swor Journal: Resuscitation Date: 2013-03-22 Impact factor: 5.262
Authors: Michael W Donnino; Justin D Salciccioli; Michael D Howell; Michael N Cocchi; Brandon Giberson; Katherine Berg; Shiva Gautam; Clifton Callaway Journal: BMJ Date: 2014-05-20
Authors: Jason A Lesnick; Justin X Moore; Yefei Zhang; Jeffrey Jarvis; Graham Nichol; Mohamud R Daya; Ahamed H Idris; Cameron Klug; David Dennis; Jestin N Carlson; Pratik Doshi; George Sopko; Robert H Schmicker; Henry E Wang Journal: Resuscitation Date: 2020-12-02 Impact factor: 5.262