Wang Henry E, Daya Mohamud R, Schmicker Robert, Nassal Michelle, Okubo Masashi, Aramendi Elisabete, Alonso Erik, Idris Ahamed, Panchal Ashish R, Jaureguibeitia Xabier, Aufderheide Tom, Carlson Jestin, Nichol Graham
The Ohio State University, USA.
Oregon Health & Science University, USA.
Resuscitation. 2024 Dec;205:110422. doi: 10.1016/j.resuscitation.2024.110422. Epub 2024 Oct 30.
While resuscitation guidelines emphasize early vasopressor administration and advanced airway management, their optimal sequence remains unclear. We sought to determine the associations between vasopressor-airway resuscitation sequence and out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART).
We analyzed data from the PART trial. For each patient we determined times of first vasopressor administration (epinephrine or vasopressin), and successful advanced airway insertion (laryngeal tube or endotracheal tube). We classified each case as vasopressor-first or advanced airway-first. We used Generalized Estimating Equations to determine associations between vasopressor-airway sequence and outcomes (72-hour survival, return of spontaneous circulation (ROSC) on emergency department arrival, survival to hospital discharge, hospital survival with favorable neurologic status) and CPR outside of recommended parameters (chest compression fraction <0.8, chest compression rate <100 or >120 per min, or ventilation rate <8 or >12 breaths/min), adjusting for confounders.
Of 3,004 patients in the parent trial, we analyzed 2,404, including 1,821 vasopressor-first and 583 advanced airway-first. Median intervention times: ALS arrival-to-vasopressor 8 min (IQR 6-11) and ALS arrival-to-airway 11 min (8-15). Compared with airway-first, vasopressor-first sequence was not associated with 72-hour survival (adjusted OR 0.96; 95% CI: 0.71-1.31), ROSC (0.83; 0.66-1.06), hospital survival (1.09; 0.68-1.73), or hospital survival with favorable neurologic status (0.97; 0.53-1.78). Vasopressor-first sequence was not associated with non-compliance with recommended CPR performance parameters.
Vasopressor-airway resuscitation sequence was not associated with OHCA outcomes or CPR quality.
虽然复苏指南强调早期使用血管活性药物和高级气道管理，但其最佳顺序仍不明确。我们试图在实用气道复苏试验（PART）中确定血管活性药物-气道复苏顺序与院外心脏骤停（OHCA）结局之间的关联。
我们分析了PART试验的数据。对于每位患者，我们确定首次使用血管活性药物（肾上腺素或血管加压素）的时间以及成功插入高级气道（喉管或气管插管）的时间。我们将每个病例分类为血管活性药物优先或高级气道优先。我们使用广义估计方程来确定血管活性药物-气道顺序与结局（72小时生存率、急诊科到达时自主循环恢复（ROSC）、出院生存率、伴有良好神经功能状态的医院生存率）以及超出推荐参数的心肺复苏（胸外按压比例<0.8、胸外按压频率<100次/分钟或>120次/分钟，或通气频率<8次/分钟或>12次/分钟）之间的关联，并对混杂因素进行校正。
在原试验的3004例患者中，我们分析了2404例，其中1821例为血管活性药物优先，583例为高级气道优先。干预时间中位数：从高级生命支持（ALS）到达至使用血管活性药物为8分钟（四分位间距6-11），从ALS到达至建立气道为11分钟（8-15）。与气道优先相比，血管活性药物优先顺序与72小时生存率（校正比值比0.96；95%置信区间：0.71-1.31）、ROSC（0.83；0.66-1.06）、出院生存率（1.09；0.68-1.73）或伴有良好神经功能状态的医院生存率（0.97；0.53-1.78）均无关联。血管活性药物优先顺序与不符合推荐的心肺复苏性能参数无关。
血管活性药物-气道复苏顺序与OHCA结局或心肺复苏质量无关。
