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Pugh A, Stoecklein H, Tonna J, Hoareau G, Johnson M, Youngquist S. Intramuscular adrenaline for out-of-hospital cardiac arrest is associated with faster drug delivery: A feasibility study. Resusc Plus 2021; 7:100142. [PMID: 34223398 PMCID: PMC8244431 DOI: 10.1016/j.resplu.2021.100142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 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. AIM 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Key Words
- AHA, American Heart Association
- CPR, cardiopulmonary resuscitation
- CQI, Care Quality Improvement
- EMS, Emergency Medical Services
- IM, intramuscular
- IO, intraosseus
- IRB, Institutional Review Board
- IV, intravenous
- Intramuscular adrenaline
- OHCA, Out of hospital cardiac arrest
- Out-of-hospital cardiac arrest (OHCA)
- PSAP, Public Safety Access Point
- ROSC, return of spontaneous circulation
- SLCFD, Salt Lake City Fire Department
- TXA, tranexamic acid
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Affiliation(s)
- A.E. Pugh
- 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
| | - H.H. Stoecklein
- 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
| | - J.E. Tonna
- 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
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, UT, USA
| | - G.L. Hoareau
- 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
- Nora Eccles Harrison Cardiovascular Research and Training Institute, USA
| | - M.A. Johnson
- 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
| | - S.T. Youngquist
- 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
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Johnson M, Tibbits E, Hoareau G, Simon M, Davidson A, DeSoucy E, Faulconer R, Grayson J, Neff L, Williams T. 288 Endovascular Variable Aortic Control Improves Cardiac Performance When Compared to Resuscitative Endovascular Balloon Occlusion of the Aorta in a Swine Model of Hemorrhagic Shock. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hoareau G, Mellema M. Pro-coagulant thromboelastographic features in the bulldog. J Small Anim Pract 2014; 56:103-7. [DOI: 10.1111/jsap.12299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 05/09/2014] [Accepted: 09/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
- G. Hoareau
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California Davis; Davis CA 95616-8747 USA
| | - M. Mellema
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California Davis; Davis CA 95616-8747 USA
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