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

Joshua R. Lupton, Robert Schmicker, Mohamud Ramzan Daya, Tom P. Aufderheide, Shannon Stephens, Nancy Le, Susanne May, Juan Carlos Puyana, Ahamed Idris, Graham Nichol, Henry Wang, Matthew Hansen

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 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.

Original languageEnglish (US)
JournalResuscitation
DOIs
StatePublished - Jan 1 2019

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Out-of-Hospital Cardiac Arrest
Epinephrine
Survival
Airway Management
Resuscitation

Keywords

  • Airway management
  • Endotracheal
  • Epinephrine
  • Out-of-hospital cardiac arrest
  • Supraglottic

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Effect of initial airway strategy on time to epinephrine administration in patients with out-of-hospital cardiac arrest. / Lupton, Joshua R.; Schmicker, Robert; Daya, Mohamud Ramzan; Aufderheide, Tom P.; Stephens, Shannon; Le, Nancy; May, Susanne; Puyana, Juan Carlos; Idris, Ahamed; Nichol, Graham; Wang, Henry; Hansen, Matthew.

In: Resuscitation, 01.01.2019.

Research output: Contribution to journalArticle

Lupton, Joshua R. ; Schmicker, Robert ; Daya, Mohamud Ramzan ; Aufderheide, Tom P. ; Stephens, Shannon ; Le, Nancy ; May, Susanne ; Puyana, Juan Carlos ; Idris, Ahamed ; Nichol, Graham ; Wang, Henry ; Hansen, Matthew. / Effect of initial airway strategy on time to epinephrine administration in patients with out-of-hospital cardiac arrest. In: Resuscitation. 2019.
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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 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.",
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AU - Lupton, Joshua R.

AU - Schmicker, Robert

AU - Daya, Mohamud Ramzan

AU - Aufderheide, Tom P.

AU - Stephens, Shannon

AU - Le, Nancy

AU - May, Susanne

AU - Puyana, Juan Carlos

AU - Idris, Ahamed

AU - Nichol, Graham

AU - Wang, Henry

AU - Hansen, Matthew

PY - 2019/1/1

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N2 - 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.

AB - 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.

KW - Airway management

KW - Endotracheal

KW - Epinephrine

KW - Out-of-hospital cardiac arrest

KW - Supraglottic

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