The Journal of emergency medicine · 2026
The Benefit of Early Advanced Airway Management Depends on Prehospital Epinephrine Timing in Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Kim Hyeong Seon, Hong Ki Jeong, Kim Ki Hong, Shin Sang Do, Song Kyoung Jun, Park Jeong Ho, Kim Min Woo, Choi Dong Hyun, Ro Young Sun, Jeong Joo, Park Yong Joo
Аннотация
BACKGROUND: The combined effect of epinephrine and advanced airway management (AAM) timing on out-of-hospital cardiac arrest (OHCA) outcomes remains poorly characterized.
OBJECTIVES: To investigate the interaction between epinephrine and AAM timing and their joint association with neurological and survival outcomes in OHCA.
METHODS: This retrospective study used Korea OHCA Registry data (August 2019-December 2023). We included adults receiving prehospital epinephrine and AAM. Epinephrine timing was early (=10 min) or late (>10 min) from emergency medical services arrival; AAM timing was early (=6 min) or late (>6 min). This yielded four groups: early epinephrine/early AAM (EE-EA), early epinephrine/late AAM (EE-LA), late epinephrine/early AAM (LE-EA), and late epinephrine/late AAM (LE-LA). Multivariable logistic regression and interaction analyses were performed for good neurological recovery (Cerebral Performance Category 1-2), survival to discharge, and prehospital return of spontaneous circulation.
RESULTS: Of 20,662 eligible patients, 37.1% were in the EE-EA group. Compared with LE-LA, the EE-EA group had significantly higher odds of good neurological recovery (adjusted odds ratio [aOR] 2.44, 95% confidence interval [CI] 1.93-3.08) and survival to discharge (aOR 2.18, 95% CI 1.87-2.55). The LE-EA group showed no significant benefit over LE-LA (aOR 0.99, 95% CI 0.71-1.40). A significant interaction between early epinephrine and early AAM was observed for neurological recovery (aOR 1.45, 95% CI 1.08-1.95; p=0.045).
CONCLUSION: Early epinephrine combined with early AAM was associated with optimal neurological recovery. However, this multiplicative interaction was attenuated in sensitivity analyses addressing resuscitation time bias, suggesting a hypothesis-generating rather than confirmatory association.
OBJECTIVES: To investigate the interaction between epinephrine and AAM timing and their joint association with neurological and survival outcomes in OHCA.
METHODS: This retrospective study used Korea OHCA Registry data (August 2019-December 2023). We included adults receiving prehospital epinephrine and AAM. Epinephrine timing was early (=10 min) or late (>10 min) from emergency medical services arrival; AAM timing was early (=6 min) or late (>6 min). This yielded four groups: early epinephrine/early AAM (EE-EA), early epinephrine/late AAM (EE-LA), late epinephrine/early AAM (LE-EA), and late epinephrine/late AAM (LE-LA). Multivariable logistic regression and interaction analyses were performed for good neurological recovery (Cerebral Performance Category 1-2), survival to discharge, and prehospital return of spontaneous circulation.
RESULTS: Of 20,662 eligible patients, 37.1% were in the EE-EA group. Compared with LE-LA, the EE-EA group had significantly higher odds of good neurological recovery (adjusted odds ratio [aOR] 2.44, 95% confidence interval [CI] 1.93-3.08) and survival to discharge (aOR 2.18, 95% CI 1.87-2.55). The LE-EA group showed no significant benefit over LE-LA (aOR 0.99, 95% CI 0.71-1.40). A significant interaction between early epinephrine and early AAM was observed for neurological recovery (aOR 1.45, 95% CI 1.08-1.95; p=0.045).
CONCLUSION: Early epinephrine combined with early AAM was associated with optimal neurological recovery. However, this multiplicative interaction was attenuated in sensitivity analyses addressing resuscitation time bias, suggesting a hypothesis-generating rather than confirmatory association.