Addition of Intramuscular Epinephrine to Standard of Care by Paramedics to Decrease Time-to-Initial Epinephrine Dose in Pediatric Out-of-Hospital Cardiac Arrest: A Simulation Trial
Bibliographic record
Abstract
Objectives Survival rates for pediatric out-of-hospital cardiac arrest (POHCA) are low at around 10%. Paramedic services administer critical interventions including epinephrine. While typically administered via intravenous (IV) or intraosseous (IO) routes, obtaining these access points in out-of-hospital emergencies is challenging. We aimed to evaluate the time to first dose epinephrine and dosing accuracy in a simulated POHCA event.Methods Paramedics were randomized to one of three epinephrine administration routes: 1) IV or IO; 2) intramuscular (IM) by autoinjector; or 3) IM by needle/syringe. Each participant was asked to provide resuscitation to a school-aged mannequin with asystole, including administration of epinephrine via their randomized route. Participants were not directly informed of the outcome variables. The primary outcome was time to initial epinephrine dose for each route. Our secondary outcomes were non-inferiority time to definitive dose epinephrine (i.e., by IV or IO), time to secure vascular access (either IO or IV), and administration of correct epinephrine dose (within 20% of correct dose).Results Sixty six paramedics participated. We demonstrated a significant reduction in time to initial dose of epinephrine of 1.5 min (p < 0.001) by the IM route using epinephrine autoinjectors compared to standard of care by IV or IO. We also demonstrated that using a needle and syringe to administer epinephrine by the IM route offered no benefit in time to initial epinephrine dose and led to more dosing errors for the definitive dose of epinephrine (i.e., by IV or IO) (n = 4). We demonstrated that time to secure vascular access after IM injection with an auto-injector was delayed by 1:07 min (p = 0.002) compared to IV/IO.Conclusions This is the first study to demonstrate that IM epinephrine by autoinjector is feasible in a simulated POHCA scenario and confers a significant advantage in time to initial dose of epinephrine. This study will inform future human trials of IM epinephrine for POHCA.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".