Intramuscular adrenaline for out-of-hospital cardiac arrest is associated with faster drug delivery: A feasibility study()

BACKGROUND: Early adrenaline administration is associated with return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA). Animal data demonstrate a similar rate of ROSC when early intramuscular (IM) adrenaline is given compared to early intravenous (IV) adrenaline. AIM: To evaluate the feasibility of protocolized first-dose IM adrenaline in OHCA and it’s effect on time from Public Safety Access Point (PSAP) call receipt to adrenaline administration when compared to IO and IV administration. METHODS: This is a before-and-after feasibility study of adult OHCAs in a single EMS service following adoption of a protocol for first-dose IM adrenaline. Time from PSAP call to administration and outcomes were compared to 674 historical controls (from January 1, 2013–February 8, 2021) who received at least one dose of adrenaline by IV or IO routes. RESULTS: During the study period, first-dose IM adrenaline was administered to 99 patients (December 1, 2019–February 8, 2021). IM adrenaline was given a median of 12.2 min (95% CI 11.4–13.1 min) after the PSAP call receipt compared to 15.3 min for the IV route (95% CI 14.6–16.0 min) and 15.3 min for the IO route (95% CI 14.9–15.7 min) with a time savings of 3 min (95% CI 2–4 min). Rates of survival to hospital discharge appeared similar between groups: 10% for IM, 8% for IV and 7% for IO. However, results related to survival were underpowered for statistical comparison. CONCLUSIONS: Within the limitations of a small sample size and before-and-after design, first-dose IM adrenaline was feasible and reduced the time to adrenaline administration.