Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trials
Abstract Objective Intranasal medications have been proposed as adjuncts to out‐of‐hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows. Methods We conducted separate randomized OHCA simulation trials with lay rescuer...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.13100 |
| _version_ | 1827292599437754368 |
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| author | Stephen R. Dowker Madison L. Downey Noor K. Majhail Isabella G. Scott Jonah Mathisson Daniel Rizk Brad Trumpower Debra Yake Michelle Williams Emilee I. Coulter‐Thompson Christine M. Brent Graham C. Smith Robert Swor David A. Berger Deborah M. Rooney Robert W. Neumar Charles P. Friedman James M. Cooke Amanda L. Missel |
| author_facet | Stephen R. Dowker Madison L. Downey Noor K. Majhail Isabella G. Scott Jonah Mathisson Daniel Rizk Brad Trumpower Debra Yake Michelle Williams Emilee I. Coulter‐Thompson Christine M. Brent Graham C. Smith Robert Swor David A. Berger Deborah M. Rooney Robert W. Neumar Charles P. Friedman James M. Cooke Amanda L. Missel |
| author_sort | Stephen R. Dowker |
| collection | DOAJ |
| description | Abstract Objective Intranasal medications have been proposed as adjuncts to out‐of‐hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows. Methods We conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands‐only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group. Results Among LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1 s, 95% CI: 14.9, 73.3), which persisted after adjustment (p = 0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2 cpm, mean diff. −9.1 cpm, 95% CI −16.6, −1.6) and CCF (INMA 62.4% vs control 69.8%, mean diff. −7.5%, 95% CI −12.0, −2.9). Among FRs, we found no significant CPR2 delays (mean diff. −2.1 s, 95% CI −15.9, 11.7), which persisted after adjustment (p = 0.704), or difference in quality (CCR INMA 115.5 cpm vs control 120.8 cpm, mean diff. −5.3 cpm, 95% CI −12.6, 2.0; CCF INMA 79.6% vs control 81.2% mean diff. −1.6%, 95% CI −7.4, 4.3%) Conclusions INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality. |
| first_indexed | 2024-03-07T22:02:19Z |
| format | Article |
| id | doaj.art-830157e80227499485be05ca6a63c2d9 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-04-24T13:07:28Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-830157e80227499485be05ca6a63c2d92024-04-05T06:10:53ZengWileyJournal of the American College of Emergency Physicians Open2688-11522024-02-0151n/an/a10.1002/emp2.13100Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trialsStephen R. Dowker0Madison L. Downey1Noor K. Majhail2Isabella G. Scott3Jonah Mathisson4Daniel Rizk5Brad Trumpower6Debra Yake7Michelle Williams8Emilee I. Coulter‐Thompson9Christine M. Brent10Graham C. Smith11Robert Swor12David A. Berger13Deborah M. Rooney14Robert W. Neumar15Charles P. Friedman16James M. Cooke17Amanda L. Missel18Department of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Internal Medicine Division of Cardiovascular Medicine University of Michigan Medical School, 2139 Cardiovascular Center Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Medical School Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Medical School Ann Arbor Michigan USADepartment of Emergency Medicine Corewell East William Beaumont University Hospital Royal Oak Michigan USADepartment of Emergency Medicine Corewell East William Beaumont University Hospital Royal Oak Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USADepartment of Learning Health Sciences University of Michigan Medical School Ann Arbor Michigan USAAbstract Objective Intranasal medications have been proposed as adjuncts to out‐of‐hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows. Methods We conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands‐only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group. Results Among LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1 s, 95% CI: 14.9, 73.3), which persisted after adjustment (p = 0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2 cpm, mean diff. −9.1 cpm, 95% CI −16.6, −1.6) and CCF (INMA 62.4% vs control 69.8%, mean diff. −7.5%, 95% CI −12.0, −2.9). Among FRs, we found no significant CPR2 delays (mean diff. −2.1 s, 95% CI −15.9, 11.7), which persisted after adjustment (p = 0.704), or difference in quality (CCR INMA 115.5 cpm vs control 120.8 cpm, mean diff. −5.3 cpm, 95% CI −12.6, 2.0; CCF INMA 79.6% vs control 81.2% mean diff. −1.6%, 95% CI −7.4, 4.3%) Conclusions INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality.https://doi.org/10.1002/emp2.13100first responderintranasallay rescuerOHCArandomized trialsimulation |
| spellingShingle | Stephen R. Dowker Madison L. Downey Noor K. Majhail Isabella G. Scott Jonah Mathisson Daniel Rizk Brad Trumpower Debra Yake Michelle Williams Emilee I. Coulter‐Thompson Christine M. Brent Graham C. Smith Robert Swor David A. Berger Deborah M. Rooney Robert W. Neumar Charles P. Friedman James M. Cooke Amanda L. Missel Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trials Journal of the American College of Emergency Physicians Open first responder intranasal lay rescuer OHCA randomized trial simulation |
| title | Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trials |
| title_full | Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trials |
| title_fullStr | Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trials |
| title_full_unstemmed | Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trials |
| title_short | Early intranasal medication administration in out‐of‐hospital cardiac arrest: Two randomized simulation trials |
| title_sort | early intranasal medication administration in out of hospital cardiac arrest two randomized simulation trials |
| topic | first responder intranasal lay rescuer OHCA randomized trial simulation |
| url | https://doi.org/10.1002/emp2.13100 |
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