Delayed adrenaline administration prolongs adrenaline-to-ROSC interval in out-of-hospital cardiac arrest

Previous investigations reveal that protracted resuscitative efforts are associated with poorer long-term patient outcomes. Aside from certain patient characteristics and interventions, such as shockable rhythms, bystander CPR and early defibrillation, little is known about factors influencing resuscitation duration and time to return of spontaneous circulation (ROSC). We hypothesised that early public safety answering point (PSAP) call-receipt-to-pressor (PSAP-to-pressor) administration would decrease the pressor-to-ROSC interval and shorten low-flow duration. Our objective was to quantify the relationship between the PSAP-to-pressor and pressor-to-ROSC intervals.

We conducted a retrospective analysis using the 2020 ESO dataset containing calls from January to December 2020. Adults with non-traumatic, bystander-witnessed arrests were included. A Cox proportional hazard model was used to determine the association between PSAP-to-pressor interval and pressor-to-ROSC interval while controlling for potential confounders. The end of the event was defined as ROSC, field termination of resuscitation or hospital arrival without ROSC. Patients without ROSC upon hospital arrival were right censored.

Overall, 10,093 patients had data sufficient for analysis. The mean age of the participants was 65.3 (±15.5) years and 64.5% were male. Presumed cardiac aetiology was present in 83.7% of arrests, 29.4% presented with a shockable rhythm and 35.9% attained ROSC. The mean PSAP-to-pressor and pressor-to-ROSC intervals were 16.2 (±5.0) and 14.6 (±11.1) minutes, respectively. The mean time from the first adrenaline administration to the end of the event was 32.7 (±1.0), 41.5 (±1.2) and 51.6 (±3.8) minutes for the 0-10-, 11-20- and 21-30-minute PSAP-to-pressor intervals, respectively (p <0.001). After controlling for confounders, the PSAP-to-pressor time interval was associated with decreased likelihood of ROSC (HR = 0.97 per minute, p <0.001). When stratified by 10-minute increments with 0-10 minutes as reference, PSAP-to-pressor was negatively associated with ROSC for the 11-20- (HR = 0.86, p = 0.002) and 21-30- (HR = 0.66, p <0.001) minute categories.

This retrospective analysis from a national database revealed that increasing delays to first adrenaline administration were associated with prolonged resuscitation duration after drug administration and decreasing likelihood of ROSC.