Cardiac arrest & resuscitation
Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest
Authors' conclusion
These findings suggest that for patients with OHCA, administration of epinephrine before placement of an advanced airway may be the optimal treatment sequence for improved patient outcomes.
Study context
- Population
- Adults (≥18 years) with out-of-hospital cardiac arrest (OHCA) given epinephrine and/or an advanced airway by EMS, Japanese OHCA registry, 2014–201921,592 shockable rhythm
- Participants
- 259,237 adults
- Exposure
- Epinephrine first vs advanced airway management first
- Outcome
- 1-month survival
- Follow-up
- 1 month
Methodological detailsnationwide, population-based registry, propensity score inverse probability of treatment weighting (IPTW)
- Nationwide, population-based registry
- Propensity score IPTW
Main finding
As reported in the abstract
1-month survival, by initial rhythm
Epinephrine-first vs AAM-firstOR for 1-month survival (95% CI)
Shockable rhythm
1.19(1.09–1.30)
Nonshockable rhythm
1.28(1.19–1.37)
Observational data: associations, not effects.
Secondary outcomes
1-month survival with favorable functional status and prehospital ROSC
- Increased likelihood in the epinephrine-first group vs advanced airway management (AAM)-first for both shockable and nonshockable rhythms
Original publication
Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. JAMA Netw Open. Published 5 February 2024. doi:10.
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