Dowker Stephen R, Downey Madison L, Majhail Noor K, Scott Isabella G, Mathisson Jonah, Rizk Daniel, Trumpower Brad, Yake Debra, Williams Michelle, Coulter-Thompson Emilee I, Brent Christine M, Smith Graham C, Swor Robert, Berger David A, Rooney Deborah M, Neumar Robert W, Friedman Charles P, Cooke James M, Missel Amanda L
Department of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USA.
Department of Internal Medicine Division of Cardiovascular Medicine University of Michigan Medical School, 2139 Cardiovascular Center Ann Arbor Michigan USA.
J Am Coll Emerg Physicians Open. 2024 Jan 21;5(1):e13100. doi: 10.1002/emp2.13100. eCollection 2024 Feb.
Intranasal medications have been proposed as adjuncts to out-of-hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows.
We conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands-only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group.
Among LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1 s, 95% CI: 14.9, 73.3), which persisted after adjustment ( = 0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2 cpm, mean diff. -9.1 cpm, 95% CI -16.6, -1.6) and CCF (INMA 62.4% vs control 69.8%, mean diff. -7.5%, 95% CI -12.0, -2.9). Among FRs, we found no significant CPR2 delays (mean diff. -2.1 s, 95% CI -15.9, 11.7), which persisted after adjustment ( = 0.704), or difference in quality (CCR INMA 115.5 cpm vs control 120.8 cpm, mean diff. -5.3 cpm, 95% CI -12.6, 2.0; CCF INMA 79.6% vs control 81.2% mean diff. -1.6%, 95% CI -7.4, 4.3%).
INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality.
鼻内给药已被提议作为院外心脏骤停（OHCA）护理的辅助手段。我们试图量化鼻内给药（INMA）在OHCA工作流程中的效果。
我们分别对非专业救援人员（LRs）和急救人员（FRs）进行了随机OHCA模拟试验。在第二个分析阶段，参与者被随机分为进行单纯胸外按压心肺复苏（CPR）/自动体外除颤器（AED）且有或无INMA的组。第二次电击后开始按压的时间（CPR2）是主要结局，按压质量（胸外按压速率（CCR）和比例（CCF））是次要结局。我们对LR组的CPR培训和FR组的工作年限进行了调整，拟合了线性回归模型。
在LRs中，INMA与CPR2显著增加相关（平均差异44.1秒，95%置信区间：14.9，73.3），调整后仍存在（P = 0.005）。我们观察到CCR显著降低（INMA为每分钟95.1次按压（cpm），对照组为104.2 cpm，平均差异-9.1 cpm，95%置信区间-16.6，-1.6）以及CCF显著降低（INMA为62.4%，对照组为69.8%，平均差异-7.5%，95%置信区间-:12.0，-2.9）。在FRs中，我们未发现CPR2有显著延迟（平均差异-2.1秒，95%置信区间-15.9，11.7），调整后仍存在（P = :0.704），也未发现质量有差异（CCR：INMA为115.5 cpm，对照组为120.8 cpm，平均差异-5.3 cpm，95%置信区间-12.6，2.0；CCF：INMA为79.6%，对照组为81.2%，平均差异-1.6%，95%置信区间-7.4，4.3%）。
LRs复苏中的INMA与复苏表现下降相关。FRs进行INMA并未妨碍关键时间或质量。
