Abstract 165: Association of Advanced Airway Placement and Time to Epinephrine Administration in Patients With Out-of-Hospital Cardiac Arrest

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a significant source of morbidity and mortality in the United States. In addition to cardiopulmonary resuscitation (CPR) and defibrillation, epinephrine and advanced airway management are often used in treatment. Recent studies suggest early administration of epinephrine is associated with improved survival. The purpose of this study was to evaluate the effect of airway type on timing to epinephrine in OHCA. Hypothesis: Patients who had laryngeal tube (LT) insertion as first attempted airway have shorter times to epinephrine administration compared to those with endotracheal intubation (ETI) as first attempted airway. Methods: Subjects enrolled in the Pragmatic Airway Resuscitation Trial who received epinephrine and primary ETI or LT were included. The dependent variable was timing to epinephrine administration after EMS arrival in minutes, the independent variable was first airway attempted (LT or ETI). Kaplan-Meier estimates of time to drug administration were used to account for censoring. Results: We included 2650 subjects (1423 LT and 1227 ETI). There were no significant differences in age, sex, first rhythm, EMS response time, witnessed arrest status, bystander CPR or proportion receiving epinephrine between the LT and ETI groups. Among all OHCA patients, LT and ETI had median minutes (95% CI) until epinephrine administration of 9.3 (9.0, 9.8) and 9.7 (9.4, 10.0), respectively (p=n.s.). For the VT/VF subgroup, the median minutes (95% CI) to epinephrine administration were 8.0 (7.8, 9.0) and 9.2 (8.7, 9.9) for LT and ETI, respectively (Figure, p=n.s.). Conclusions: Overall, advanced airway type did not affect time to epinephrine. Among those with initial VT/VF, there is a weak, non-statistically significant trend of longer time to epinephrine when ETI is used compared to LT. This difference may be a contributing component to improved survival with an initial LT airway strategy for OHCA.