Time to epinephrine tied to survival in non-shockable OHCA

(HealthDay)—For patients with out-of-hospital cardiac arrest (OHCA) with non-shockable initial rhythm, each minute delay in epinephrine administration is associated with reduced survival and unfavorable neurologic outcomes, according to a study published online March 6 in Circulation.

Matthew Hansen, M.D., from the Oregon Health & Science University in Portland, and colleagues performed a secondary analysis of prospectively identified OHCAs. Patients of all ages with an OHCA treated by emergency medical services (EMS) and an initial non-shockable rhythm were included; a subgroup analysis was conducted involving patients aged <18 years. Data were included for 32,101 patients with initial non-shockable rhythms.

Of the patients, there were 12,238 in the early group (exposure to epinephrine <10 minutes), 14,517 in the late group (exposure to epinephrine ≥10 minutes), and 5,346 in a group not treated with epinephrine. The researchers found that each minute from EMS arrival to epinephrine administration was associated with a 4 percent decrease in the odds of survival for adults, after adjustment for potential confounders (odds ratio [OR], 0.96). A similar association was seen in subgroup analysis examining neurological outcomes (adjusted OR, 0.94 per minute). Compared with the early group, the late group had lower odds of survival (OR, 0.82). In a pediatric analysis, for each minute delay in epinephrine the odds of survival were 9 percent lower (OR, 0.91).

"EMS agencies should consider strategies to reduce epinephrine administration times in patients with initial non-shockable rhythms," the authors write.