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  • IM Epinephrine for OHCA – Quicker and Better?

    Written by Michael Stocker


    In non-traumatic out of hospital cardiac arrest (OHCA), administration of an initial dose of IM epinephrine by EMS prior to an established IV or IO was associated with improved survival outcomes.

    Epi in the thigh helps more patients survive?

    This single-center before-and-after study investigated the effect of an initial IM epinephrine dose in OHCA on survival outcomes. Subsequent to a pre-intervention phase with paramedics following standard ACLS protocols (IV/IO), the intervention phase (IM) saw the addition of an initial 5mg IM epinephrine dose while attempts to establish IV/IO access were ongoing. 1,405 adult OHCA patients (IM group, n = 420) regardless of initial rhythm were included after exclusions such as ROSC before epinephrine and traumatic arrest. Demographics were similar between the groups, with differences in age and bystander CPR favoring the IM group.  After adjusting for demographics, bystander CPR, and EMS response time, the IM group saw improvement in all measured survival outcomes: survival to hospital admission (37.1% vs 31.6%; adjusted odds ratio [aOR] 1.37, 95%CI 1.06-1.77), survival to hospital discharge (11.0% vs 7.0%; aOR 1.73, 95%CI 1.10-2.71), and neurologically favorable survival (9.8% vs 6.2%; aOR 1.72, 95%CI 1.07-2.76). As may be expected, time to first epinephrine was also shorter in the IM group. There were a host of limitations, from sample size and protocol deviations to the COVID-19 pandemic during the intervention phase; however, the goal of providing motivation for further investigation was achieved.

    How will this change my practice?

    This study is not practice changing on its own, yet I’m cautiously optimistic. As medicine becomes ever more sophisticated, wouldn’t it be great if straightforward IM epinephrine were the “next big thing” in OHCA care? There should be enough potential for benefit here to warrant rigorous investigation – bring on the RCTs!

    Source

    Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. Epub 2024 Jun 9. PMID: 38857847.

    The post IM Epinephrine for OHCA – Quicker and Better? first appeared on האיגוד הישראלי לרפואה דחופה.

    13 min
  • PODCAST: Acute Pain Management in the ED
    Grand Rounds – Dr. Sergey Motov – Acute Pain Management in the ED
    December 14, 2022

    Dr. Sergey Motov, gave this presentation on acute pain management to the Mayo EM Grand Rounds audience in the fall of 2022.

    Pain is the most common reason for people to seek care in the Emergency Department. The current laws and regulations have significantly affected ED Clinician’s ability to provide effective, efficient and safe pain relief by worsening opiophobia, by repurposing non-analgesic medications for pain control and by proliferation of dangerous drug-drug combinations. This talks is set to discuss the current state of ED analgesia when it comes to acute pain management with a primary focus on what works and what does not.

    The post PODCAST: Acute Pain Management in the ED first appeared on האיגוד הישראלי לרפואה דחופה.

    1 hr 10 min

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The Israel Association for Emergency Medicine