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

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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).

Original languageEnglish (US)
Pages (from-to)180-185
Number of pages6
JournalResuscitation
Volume96
DOIs
StatePublished - Nov 1 2015

Fingerprint

Out-of-Hospital Cardiac Arrest
Epinephrine
Survival
Emergency Medical Services
Logistic Models
Resuscitation
Confidence Intervals
Nervous System
Odds Ratio
Databases

Keywords

  • Asystole
  • Cardiac arrest
  • Emergency medical services
  • Epinephrine
  • Pulseless electrical activity
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

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title = "The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest",
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).",
keywords = "Asystole, Cardiac arrest, Emergency medical services, Epinephrine, Pulseless electrical activity, Ventricular fibrillation",
author = "Ewy, {Gordon A.} and Bobrow, {Bentley J} and Vatsal Chikani and Sanders, {Arthur B} and Otto, {Charles W} and Spaite, {Daniel W} and Kern, {Karl B}",
year = "2015",
month = "11",
day = "1",
doi = "10.1016/j.resuscitation.2015.08.011",
language = "English (US)",
volume = "96",
pages = "180--185",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",

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T1 - The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest

AU - Ewy, Gordon A.

AU - Bobrow, Bentley J

AU - Chikani, Vatsal

AU - Sanders, Arthur B

AU - Otto, Charles W

AU - Spaite, Daniel W

AU - Kern, Karl B

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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).

AB - 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).

KW - Asystole

KW - Cardiac arrest

KW - Emergency medical services

KW - Epinephrine

KW - Pulseless electrical activity

KW - Ventricular fibrillation

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