Abstract 390: Pre-Hospital Administered Adrenaline in the Presence of a Physician and Neurological Status of Patients With Out-of-Hospital Cardiac Arrest: A Multi-Center Prospective Cohort Study

Abstract

Background: Little is known about whether pre-hospital administered adrenaline with a physician present could improve the outcome of patients with cardiac arrest. Hypothesis and Aim: We aimed to test the hypothesis that pre-hospital administered adrenaline provided in the presence of a physician could improve neurological survival of patients with a specific type of first-confirmed cardiac rhythm following cardiac arrest compared with pre-hospital administered adrenaline provided in the absence of a physician. Methods: This prospective multi-center cohort study enrolled consecutive patients who were transported to 95 participating hospitals in Japan after out-of-hospital cardiac arrest and later underwent resuscitation at a hospital between June 1 2014 and December 31 2020. We included patients who were administered pre-hospital adrenaline under the presence or absence of a physician, and who were ≥18 years of age with cardiac arrest of a medical etiology. Primary outcome was a favorable neurological outcome (Cerebral Performance Category score of 1 or 2) one month after cardiac arrest. Whether the carotid artery was pulsating and 3-lead electrocardiogram monitor confirmed the first cardiac rhythm. Based on previous findings, those with the first-confirmed cardiac rhythm were subdivided into the non-shockable and shockable groups. Multivariable logistic regression analysis was performed on propensity score-matched patients. Results: We analyzed 11,711 patients. Among the 10,113 patients in the non-shockable group, 0.6% (N = 64) had a favorable neurological outcome. The adjusted odds ratio for a favorable neurologic outcome of pre-hospital administered adrenaline under the presence of a physician was 3.94 (95% confidence interval (CI): 1.58-11.4), compared with the absence of a physician. Of 1,598 patients in the shockable group, 10.3% (N = 164) had a favorable neurological outcome with an adjusted odds ratio of 1.30 (95% CI: 0.73-2.35). Conclusion: This prospective multi-center cohort study showed that pre-hospital administered adrenaline in the presence of a physician was significantly associated with a higher favorable neurological outcome in non-shockable patients with cardiac arrest.