Abstract 182: Prehospital Intravenous Epinephrine May Boost Survival of Patients with Traumatic Cardiopulmonary Arrest

Background: Prehospital resuscitation for patients with major trauma emphasized load-and-go principle. However, for those with traumatic cardiopulmonary arrest (TCPA), the role of prehospital intravenous epinephrine (PIE) remained unclear. This study aimed to evaluate the effectiveness of PIE in patients with TCPA. Method: We analyzed data from an Utstein registry for out-of-hospital cardiac arrest in Taipei to test the association between PIE and outcomes of TCPAs. Enrollees were adult patients (≧18 year-old) with TCPA. Patients with signs of obvious death like decapitation or rigor mortis, or with existing do-not-resuscitation order were excluded. Primary outcome was survival to admission, and secondary outcome was survival to discharge. A subgroup analysis was performed by stratified total prehospital time. Result: From Jun 1, 2010 to May 31, 2013 there were total 514 cases enrolled. PIE was administrated in 43 (8.4%) cases. Patients who received PIE were more likely with witnessed collapse, initial shockable rhythm, placement of advanced airway, longer total prehospital time and less blunt injury. Patient number with survival to admission and survival to discharge was 101 (19.6%) and 20 (3.9%), respectively. In parsimonious models, the adjusted odds ratios (AOR) of PIE was 2.57 (95% confidence interval (CI) 1.24-5.31) on primary outcome (Figure 1), and 3.53 (95%CI 0.84-15.47) on secondary outcome. Subgroup analysis showed increased ORs of PIE in cases with longer prehospital time (Figure 2). Conclusion: Among patients with TCPA, PIE was associated with increased survival to admission in an Asian metropolitan area, especially for those with longer prehospital time.