TY - JOUR
T1 - Intravenous versus intraosseous adrenaline administration in out-of-hospital cardiac arrest
T2 - A retrospective cohort study
AU - Zhang, Yongshu
AU - Zhu, Jieming
AU - Liu, Zhihao
AU - Gu, Liwen
AU - Zhang, Wanwan
AU - Zhan, Hong
AU - Hu, Chunlin
AU - Liao, Jinli
AU - Xiong, Yan
AU - Idris, Ahamed H.
N1 - Funding Information:
This study was partly supported by a grant from the National Heart, Lung, and Blood Institute ( U01HL077887 ). Dr. Yan Xiong, was a visiting reciprocal scholar and research fellow at the University of Texas Southwestern Medical Center at Dallas, and was supported by the Training Funds for Young Scholars of Sun Yat-sen University ( 11ykpy14 ) from China. This project was also supported by National Natural Scientific Foundation of China ( 81602660 ) and Guangdong Natural Science Foundation ( 2016A030310159 ).
Funding Information:
This study was partly supported by a grant from the National Heart, Lung, and Blood Institute (U01HL077887). Dr. Yan Xiong, was a visiting reciprocal scholar and research fellow at the University of Texas Southwestern Medical Center at Dallas, and was supported by the Training Funds for Young Scholars of Sun Yat-sen University (11ykpy14) from China. This project was also supported by National Natural Scientific Foundation of China (81602660) and Guangdong Natural Science Foundation (2016A030310159). We would like to thank the National Institutes of Health for making the anonymous dataset of ROC research resources available for public application and use. We are also indebted to all people who participated in the ROC, including firefighters and paramedics, for their extraordinary diligence, hard work and dedication.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/4
Y1 - 2020/4
N2 - Background: Adrenaline is an important component in the resuscitation of individuals experiencing out-of-hospital cardiac arrest (OHCA). The 2018 Advanced Cardiac Life Support (ACLS) algorithm gives the option of either intravenous (IV) or intraosseous (IO) routes for adrenaline administration during cardiac arrest. However, the optimal route during prehospital resuscitation remains controversial. This study aims to investigate whether IV and IO routes lead to different outcomes in OHCA patients who received prehospital adrenaline. Methods: This retrospective analysis included adult patients with OHCA of presumed cardiac origin who had Emergency Medical Services (EMS) CPR, received adrenaline, and were enrolled in the Resuscitation Outcomes Consortium (ROC) Cardiac Epistry version 3 database between 2011 and 2015. We divided the study population into IV and IO groups based on the administration route. Logistic regression analysis was performed to evaluate the association between adrenaline delivery routes and prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and favorable neurological outcome. Results: Of the 35,733 patients included, 27,758 (77.7%) had adrenaline administered via IV access and 7975 (22.3%) via IO access. With the IO group as a reference in the logistic regression model, the adjusted odds ratios of the IV group for prehospital ROSC, survival and favorable neurological outcome were 1.367 (95%CI, 1.276–1.464), 1.468 (95%CI, 1.264–1.705) and 1.849 (95%CI, 1.526–2.240), respectively. Similar results were found in the propensity score matched population and subgroup analysis. Conclusion: Compared with the IO approach, the IV approach appears to be the optimal route for adrenaline administration in advanced life support for OHCA during prehospital resuscitation.
AB - Background: Adrenaline is an important component in the resuscitation of individuals experiencing out-of-hospital cardiac arrest (OHCA). The 2018 Advanced Cardiac Life Support (ACLS) algorithm gives the option of either intravenous (IV) or intraosseous (IO) routes for adrenaline administration during cardiac arrest. However, the optimal route during prehospital resuscitation remains controversial. This study aims to investigate whether IV and IO routes lead to different outcomes in OHCA patients who received prehospital adrenaline. Methods: This retrospective analysis included adult patients with OHCA of presumed cardiac origin who had Emergency Medical Services (EMS) CPR, received adrenaline, and were enrolled in the Resuscitation Outcomes Consortium (ROC) Cardiac Epistry version 3 database between 2011 and 2015. We divided the study population into IV and IO groups based on the administration route. Logistic regression analysis was performed to evaluate the association between adrenaline delivery routes and prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and favorable neurological outcome. Results: Of the 35,733 patients included, 27,758 (77.7%) had adrenaline administered via IV access and 7975 (22.3%) via IO access. With the IO group as a reference in the logistic regression model, the adjusted odds ratios of the IV group for prehospital ROSC, survival and favorable neurological outcome were 1.367 (95%CI, 1.276–1.464), 1.468 (95%CI, 1.264–1.705) and 1.849 (95%CI, 1.526–2.240), respectively. Similar results were found in the propensity score matched population and subgroup analysis. Conclusion: Compared with the IO approach, the IV approach appears to be the optimal route for adrenaline administration in advanced life support for OHCA during prehospital resuscitation.
KW - Adrenaline
KW - Intraosseous
KW - Intravenous
KW - Out-of-hospital cardiac arrest
KW - Outcomes
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U2 - 10.1016/j.resuscitation.2020.01.009
DO - 10.1016/j.resuscitation.2020.01.009
M3 - Article
C2 - 31982506
AN - SCOPUS:85078419979
VL - 149
SP - 209
EP - 216
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
ER -