Early intranasal medication administration in out-of-hospital cardiac arrest: Two randomized simulation trials.

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. 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. 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 ( INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality.

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© 2024 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.

Déclaration de conflit d'intérêts

Mr. Dowker reports grant‐funding from the National Institutes of Health (grant R01‐HL137964), travel support from National Association of EMS Physicians (NAEMSP)/GMR Foundation, and concurrent employment as a firefighter/EMT with the Green Oak Charter Township Fire Department a licensed nontransporting Basic Life Support (BLS) agency in Michigan. Ms. Majhail and Ms. Scott report employment, during one or more phases of the study, with Emergent Health Partners, a licensed transporting Advanced Life Support (ALS) agency that serves as a regional provider of BLS/ALS medical transport and 911 dispatched emergency response in southern Michigan. Dr. Brent reports a leadership position for the Washtenaw/Livingston Medical Control Authority, she is an Air Medical Physician Association Board Member, NAEMSP Air Medical Committee Vice Chair, NAEMSP Council of EMS Fellowship Directors Vice Chair, and grant funding CMB Toyota Grant on Prehospital Medical Drones, and travel support from Air Medical Physician Association. Dr. Smith reports effort as associate medical director for the Washtenaw/Livingston Medical Control Authority, a regional EMS oversight body. Dr. Berger reports grant funding from AHRQ R01 HS025411‐02BCBSM Foundation, Dr. Neumar reports the following grant support National Institutes of Health: K12HL133304, R01HL133129, R34HL130738 ‐ Institution; Laerdal Foundation‐Institution, and he is SaveMiHeart President and Board Chair, ILCOR cochair. All other authors report no relevant interests.