Optimal timing of prehospital advanced airway management and epinephrine administration for out-of-hospital cardiac arrest

摘要 这项R21补助金提案的首要目标是确定院前提前生命的最佳时机 对院外心脏骤停（OHCA）患者的ALS支持干预。ALS干预措施 包括高级气道管理（AAM：即，气管内插管和声门上气道放置） 和肾上腺素给药。OHCA是全球范围内的一个重大公共卫生问题，每年影响超过 356，000名美国人的死亡率和功能性残疾率相当高。紧急医疗 EMS服务（EMS）通过提供初始院前护理，包括 在现场进行ALS干预。然而，ALS干预的最佳时机仍不清楚。2019年 国际复苏联络委员会（ILCOR）总结声明，国际共识， 心脏复苏和紧急心血管护理科学与治疗 建议将AAM和肾上腺素给药的最佳时间确定为关键知识 差距。我们最近发现，对于既有可电击节律又有不可电击节律的成年人， 使用复苏结局联盟（ROC）注册表， 美国和加拿大的大型多中心OHCA登记研究。该R21赠款项目建议进一步 将我们的研究扩展到AAM和儿科人群，分析ROC数据。具体研究目标 包括确定成人患者AAM（Aim 1A）和气管插管（Aim 1B）的最佳时机 在OHCA中，AAM（Aim 2A）和气管插管（Aim 2B）的最佳时机适用于儿科患者 与OHCA，肾上腺素（Aim3）的最佳时机与OHCA儿科患者。R21补助金 申请将为主要研究者（PI）提供受保护的时间，以实现研究目标， OHCA患者的结局。这项R21提案的结果将提供有关时间安排的关键信息。 OHCA的ALS干预措施，并为未来的国家和国际复苏指南提供信息。

ABSTRACT The overarching goal of this R21 Grant proposal is to identify the optimal timing of prehospital advance life support (ALS) interventions for patients with out-of-hospital cardiac arrest (OHCA). The ALS interventions include advanced airway management (AAM: i.e., endotracheal intubation and supraglottic airway placement) and epinephrine administration. OHCA is a major public health problem worldwide, annually affecting over 356,000 Americans with substantially high rates of mortality and functional disability. Emergency medical services (EMS) play an important role for patients with OHCA by providing initial prehospital care, including the ALS interventions in the field. However, the optimal timing of the ALS interventions remains unclear. The 2019 International Liaison Committee on Resuscitation (ILCOR) Summary Statement, International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations identified the optimal time of both AAM and epinephrine administration as key knowledge gaps. We recently found that, for adults with both shockable and nonshockable rhythms, benefit of epinephrine decreased as the administration was delayed, using the Resuscitation Outcomes Consortium (ROC) registry, a large multicenter OHCA registry in the United States and Canada. This R21 Grant project proposes to further expand our research into AAM and pediatric population, analyzing the ROC data. Specific research Aims include identifying the optimal timing of AAM (Aim 1A) and endotracheal intubation (Aim 1B) for adult patients with OHCA, the optimal timing of AAM (Aim 2A) and endotracheal intubation (Aim 2B) for pediatric patients with OHCA, and the optimal timing of epinephrine (Aim3) for pediatric patients with OHCA. This R21 Grant application will provide the Principal Investigator (PI) with protected time to achieve research aims to improve outcomes for patients with OHCA. The results of this R21 proposal will provide crucial information on the timing of ALS interventions for OHCA and inform future national and international resuscitation guidelines.