Abstract Sat1201: Sequence of Epinephrine Administration and Advanced Airway Management for Adult Patients with Out-of-Hospital Cardiac Arrest
Bibliographic record
Abstract
Introduction: Epinephrine administration and advanced airway management (AAM) (i.e., supraglottic airway insertion or endotracheal intubation) are commonly performed prehospital interventions for out-of-hospital cardiac arrest (OHCA). The optimal sequence of these two interventions remains unclear. Research Question: Is the sequence of epinephrine administration and AAM associated with patient outcomes after OHCA? Methods: We conducted a retrospective cohort study of adults (aged≥18 years) with nontraumatic OHCA who received prehospital epinephrine and/or AAM during cardiac arrest in the Resuscitation Outcomes Consortium Registry, a prospective OHCA registry at 10 sites in the US and Canada from 2011 to 2015. The main exposure was the sequence of intravenous or intraosseous epinephrine administration and AAM (epinephrine-first vs. AAM-first). The outcome was survival to hospital discharge. We used propensity scores and inverse probability of treatment weighting (IPTW) to address imbalances in patient demographics, arrest characteristics, and bystander interventions for each sub-cohort of initial shockable and nonshockable rhythms. Results: Of 41,659 eligible patients (median [IQR] age, 67 [55-80] years), 26,535 (63.7%) were male. 8,431 patients (20.2%) had an initial shockable rhythm, and 33,228 (79.8%) had an initial nonshockable rhythm. Among patients with a shockable rhythm, 5,846 received epinephrine first, 2,272 received AAM first, and 313 received epinephrine and AAM concurrently. In patients with a nonshockable rhythm, 21,519 received epinephrine first, 10,365 received AAM first, and 1,344 received epinephrine and AAM concurrently. Using IPTW, all covariates between the epinephrine-first and AAM-first groups were well balanced (standardized mean differences <0.1). Compared with the AAM-first group, in the weighted population, the epinephrine-first group was not associated with survival to hospital discharge in the shockable rhythm (OR 1.00, 95% CI 0.92-1.08), but had a lower likelihood of survival to hospital discharge in the nonshockable rhythm (OR 0.80, 95% CI 0.74-0.87). Conclusion: In the shockable rhythm, the epinephrine-first approach was not associated with survival to hospital discharge. In the nonshockable rhythm, the epinephrine-first approach was associated with a lower likelihood of survival to hospital discharge, suggesting that the AAM-first approach might be the optimal strategy in the initial nonshockable rhythm.
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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 | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".