The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest.

TitleThe time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest.
Publication TypeJournal Article
Year of Publication2015
AuthorsEwy GA, Bobrow BJ, Chikani V, Sanders AB, Otto CW, Spaite DW, Kern KB
JournalResuscitation
Volume96
Pagination180-185
Date Published2015 Aug 22
ISSN Number1873-1570
Abstract

BACKGROUND: Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial.

PURPOSE: To investigate the possible time-dependent outcomes associated with adrenaline administration by Emergency Medical Services personnel (EMS).

METHODS: A retrospective analysis of prospectively collected data from a near statewide cardiac resuscitation database between 1 January 2005 and 30 November 2013. Multivariable logistic regression was used to analyze the effect of the time interval between EMS dispatch and the initial dose of adrenaline on survival. The primary endpoints were survival to hospital discharge and favourable neurologic outcome.

RESULTS: Data from 3469 patients with witnessed OHCA were analyzed. Their mean age was 66.3 years and 69% were male. An initially shockable rhythm was present in 41.8% of patients. Based on a multivariable logistic regression model with initial adrenaline administration time interval (AATI) from EMS dispatch as the covariate, survival was greatest when adrenaline was administered very early but decreased rapidly with increasing (AATI); odds ratio 0.94 (95% Confidence Interval (CI) 0.92-0.97). The AATI had no significant effect on good neurological outcome (OR=0.96, 95% CI=0.90-1.02).

CONCLUSIONS: In patients with OHCA, survival to hospital discharge was greater in those treated early with adrenaline by EMS especially in the subset of patients with a shockable rhythm. However survival rapidly decreased with increasing adrenaline administration time intervals (AATI).

DOI10.1016/j.resuscitation.2015.08.011
Alternate JournalResuscitation
PubMed ID26307453
Faculty Reference: 
Daniel W. Spaite, MD