Background: Early adrenaline administration is associated with return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA). Animal data demonstrate a similar rate of ROSC when early intramuscular (IM) adrenaline is given compared to early intravenous (IV) adrenaline.
Aim: To evaluate the feasibility of protocolized first-dose IM adrenaline in OHCA and it's effect on time from Public Safety Access Point (PSAP) call receipt to adrenaline administration when compared to IO and IV administration.
Methods: This is a before-and-after feasibility study of adult OHCAs in a single EMS service following adoption of a protocol for first-dose IM adrenaline. Time from PSAP call to administration and outcomes were compared to 674 historical controls (from January 1, 2013-February 8, 2021) who received at least one dose of adrenaline by IV or IO routes.
Results: During the study period, first-dose IM adrenaline was administered to 99 patients (December 1, 2019-February 8, 2021). IM adrenaline was given a median of 12.2 min (95% CI 11.4-13.1 min) after the PSAP call receipt compared to 15.3 min for the IV route (95% CI 14.6-16.0 min) and 15.3 min for the IO route (95% CI 14.9-15.7 min) with a time savings of 3 min (95% CI 2-4 min). Rates of survival to hospital discharge appeared similar between groups: 10% for IM, 8% for IV and 7% for IO. However, results related to survival were underpowered for statistical comparison.
Conclusions: Within the limitations of a small sample size and before-and-after design, first-dose IM adrenaline was feasible and reduced the time to adrenaline administration.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244431 | PMC |
| http://dx.doi.org/10.1016/j.resplu.2021.100142 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Evaluating Practice Patterns of Observation Periods Following Epinephrine Administration for Anaphylaxis Among Pediatric Patients.
Cureus
September 2024
Department of Pediatric Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Article Synopsis
- - Current guidelines suggest observing anaphylactic patients for 4-6 hours after receiving epinephrine, but there's conflicting evidence about its effectiveness, especially for children.
- - This study looked at pediatric patients treated for anaphylaxis in a single ED from 2017-2022 to see how often biphasic reactions occurred and if the observation periods were adequate.
- - Out of 292 patients observed for an average of about 233 minutes, only 3.4% developed biphasic reactions, with no significant differences found in observation duration or timing of epinephrine administration between those who did and did not experience these reactions.
Association of diastolic blood pressure with coronary perfusion pressure during resuscitation in pediatric swine.
Pediatr Res
July 2024
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Article Synopsis
- Diastolic blood pressure (DBP) is proposed as a reliable indicator of coronary perfusion pressure (CPP) during CPR, and this study analyzed their correlation with survival outcomes in a pediatric swine model of cardiac arrest.
- The analysis of 102 pediatric swine resuscitations showed that both DBP and CPP were higher in survivors compared to non-survivors, especially after the first epinephrine dosage, with specific predictive thresholds identified for each measurement.
- Findings suggest that monitoring DBP could be crucial during resuscitation efforts, as it closely reflects CPP and is associated with better survival rates, making it a practical target for enhancing the effectiveness of CPR.
Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest.
Resuscitation
August 2024
Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Salt Lake City Fire Department, Salt Lake City, UT, United States.
Background: Early administration of adrenaline is associated with improved survival after out-of-hospital cardiac arrest (OHCA). Delays in vascular access may impact the timely delivery of adrenaline. Novel methods for administering adrenaline before vascular access may enhance survival.
View Article and Find Full Text PDFDirect Umbilical Vein Injection of Epinephrine with Cut-Cord Milking in an Ovine Model of Neonatal Resuscitation.
Children (Basel)
April 2024
Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA.
Background: An umbilical venous catheter (UVC) is the preferred route of epinephrine administration during neonatal resuscitation but requires specialized equipment, expertise, and time.
Hypothesis: Direct injection of epinephrine into the umbilical vein (UV) followed by milking a ~20 cm segment of cut umbilical cord to flush the epinephrine (DUV + UCM) will lead to a quicker administration and earlier return of spontaneous circulation (ROSC) compared with epinephrine given through a UVC.
Design: Eighteen near-term asphyxiated lambs were randomized to receive a low-UVC or DUV + UCM of epinephrine at 0.
Cardiac resternotomy after cardiac surgery in kids: CRACK the chest.
Cardiol Young
August 2024
Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan/Central Michigan University, Detroit, MI, USA.
Objective: Emergent resuscitation of postoperative paediatric cardiac surgical patients requires specialised skills and multidisciplinary teamwork. Bedside resternotomy is a rare but life-saving procedure and few studies focus on ways to prepare providers and improve performance. We created a multidisciplinary educational intervention that addressed teamwork and technical skills.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!