Abstract 149: Epinephrine Administration First Versus Advanced Airway Management First For Adult Patients With Out-of-hospital Cardiac Arrest

Abstract

Introduction: Epinephrine administration and advanced airway management (AAM: ie, endotracheal intubation and supraglottic airway placement) have been commonly used for patients with out-of-hospital cardiac arrest (OHCA). However, the optimal sequence of these interventions remains unclear. We, therefore, compared epinephrine administration 1 st strategy with AAM 1 st strategy. Methods: We conducted a secondary analysis of a prospective, nationwide, population-based OHCA registry in Japan. We included emergency medical services (EMS)-treated adult (≥18 years) OHCA from 2014 through 2019, stratified into shockable or nonshockable rhythms. We excluded those who did not receive epinephrine or AAM. The primary outcome was 1-month survival and the secondary outcome was 1-month survival with favorable functional status, defined as a Cerebral Performance Category scale 1 or 2. To account for treatment selection bias between patients who received epinephrine before AAM and patients who received AAM before epinephrine, we calculated propensity score and used inverse probability treatment weighting analyses. Results: We included 8,854 patients with shockable and 79,687 patients with nonshockable rhythm. 1,825 patients (20.6%) of shockable rhythms and 11,769 patients (14.8%) of nonshockable rhythm received epinephrine before AAM. Among patients with shockable rhythm, epinephrine administration before AAM was associated with lower odds of 1-month survival (Odds ratio [OR] 0.83, 95% confidence interval [CI] 0.76 to 0.90) but not associated with favorable functional outcome (OR 0.94, 95% CI 0.82 to 1.70). Among patients with nonshockable rhythm, epinephrine administration before AAM was not associated with 1-month survival (OR 0.96, 95% CI 0.91 to 1.01) but was associated with higher odds of favorable functional status (OR 1.15, 95% CI 1.002 to 1.33). Conclusions: In this observational study, we found that epinephrine administration before AAM was associated with lower odds of 1-month survival among shockable rhythm but was associated with higher odds of 1-month survival with favorable functional status among nonshockable rhythm, suggesting that the optimal sequence of epinephrine administration and AAM may vary between initial rhythms.