Pugh A E, Stoecklein H H, Tonna J E, Hoareau G L, Johnson M A, Youngquist S T
Division of Emergency Medicine, Division of Surgery, University of Utah School of Medicine, 30 North 1900 East, Room 1C26 SOM, Salt Lake City, UT 84132, USA.
Salt Lake City Fire Department, Salt Lake City, UT, USA.
Resusc Plus. 2021 May 31;7:100142. doi: 10.1016/j.resplu.2021.100142. eCollection 2021 Sep.
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.
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.
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.
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.
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.
早期给予肾上腺素与院外心脏骤停（OHCA）患者自主循环恢复（ROSC）及存活相关。动物数据表明，早期肌肉注射（IM）肾上腺素与早期静脉注射（IV）肾上腺素相比，ROSC发生率相似。
评估在OHCA中按方案给予首剂IM肾上腺素的可行性，以及与骨内注射（IO）和IV给药相比，其对从公共安全接入点（PSAP）接到呼叫到给予肾上腺素的时间的影响。
这是一项在单一急救医疗服务机构中对成年OHCA患者进行的前后可行性研究，该机构采用了首剂IM肾上腺素方案。将从PSAP呼叫到给药的时间及结果与674例历史对照（2013年1月1日至2021年2月8日）进行比较，这些历史对照通过IV或IO途径接受了至少一剂肾上腺素。
在研究期间，对99例患者给予了首剂IM肾上腺素（2019年12月1日至2021年2月8日）。在接到PSAP呼叫后，给予IM肾上腺素的中位时间为12.2分钟（95%CI 11.4 - 13.1分钟），IV途径为15.3分钟（95%CI 14.6 - 16.0分钟），IO途径为15.3分钟（95%CI 14.9 - 15.7分钟），时间节省了3分钟（95%CI 2 - 4分钟）。各组间出院存活率似乎相似：IM组为10%，IV组为8%，IO组为7%。然而，与存活相关的结果因统计学比较的效能不足。
在样本量小和前后设计的局限性内，首剂IM肾上腺素是可行的，并减少了给予肾上腺素的时间。
