Evidence map›Paper›PMID 39486473›Full record

Trial reportResuscitation2024

Vasopressor or advanced airway first in cardiac arrest?

Henry E Wang, Mohamud R Daya, Robert Schmicker, Michelle Nassal, Masashi Okubo, Elisabete Aramendi, Erik Alonso, Ahamed Idris, Ashish R Panchal, Xabier Jaureguibeitia and 3 more

Abstract readRandomized Controlled TrialPragmatic Clinical Trial
In one paragraph

Trial report in Resuscitation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Henry E WangThe Ohio State University, USA. Electronic address: Henry.wang@osumc.edu.
Mohamud R DayaOregon Health & Science University, USA. Electronic address: dayam@ohsu.edu.
Robert SchmickerUniversity of Washington, USA. Electronic address: rschmick@uw.edu.
Michelle NassalThe Ohio State University, USA. Electronic address: Michelle.nassal@osumc.edu.
Masashi OkuboUniversity of Pittsburgh, USA. Electronic address: okubom@upmc.edu.
Elisabete AramendiUniversity of the Basque Country, Spain. Electronic address: elisabete.aramendi@ehu.eus.
Erik AlonsoUniversity of the Basque Country, Spain. Electronic address: erik.alonso@ehu.eus.
Ahamed IdrisUniversity of Texas Southwestern Medical Center, USA. Electronic address: Ahamed.Idris@UTSouthwestern.edu.
Ashish R PanchalThe Ohio State University, USA. Electronic address: Ashish.panchal@osumc.edu.
Xabier JaureguibeitiaUniversity of the Basque Country, Spain. Electronic address: xabier.jaureguibeitia@ehu.eus.
Tom AufderheideMedical College of Wisconsin, USA. Electronic address: TAufderh@mcw.edu.
Jestin CarlsonUniversity of Pittsburgh, USA. Electronic address: jcarlson@usacs.com.
Graham NicholUniversity of Washington, USA. Electronic address: nichol@uw.edu.

Funding

Pragmatic Trial of Airway Management in Out-of-Hospital Cardiac ArrestUH3HL125163 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI KERBY, JEFFREY D, WANG, HENRY E. · 2015 to 2018
$2.7M
Artificial Intelligence for Dynamic, individualized CPR guidance: AID CPRK08HL168330 · NHLBI · OHIO STATE UNIVERSITY · PI Michelle M.J. Nassal · 2023 to 2026
$646k
Pragmatic Trial of Airway Management in Out-of-Hospital Cardiac ArrestUH2HL125163 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI WANG, HENRY E. · 2014 to 2014
$481k
NHLBI NIH HHS K08 HL168330NHLBI NIH HHS UH2 HL125163NHLBI NIH HHS UH3 HL125163
6 · The paper itself

Abstract

backgroundWhile resuscitation guidelines emphasize early vasopressor administration and advanced airway management, their optimal sequence remains unclear. We sought to determine the associations between vasopressor-airway resuscitation sequence and out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART).

methodsWe analyzed data from the PART trial. For each patient we determined times of first vasopressor administration (epinephrine or vasopressin), and successful advanced airway insertion (laryngeal tube or endotracheal tube). We classified each case as vasopressor-first or advanced airway-first. We used Generalized Estimating Equations to determine associations between vasopressor-airway sequence and outcomes (72-hour survival, return of spontaneous circulation (ROSC) on emergency department arrival, survival to hospital discharge, hospital survival with favorable neurologic status) and CPR outside of recommended parameters (chest compression fraction <0.8, chest compression rate <100 or >120 per min, or ventilation rate <8 or >12 breaths/min), adjusting for confounders.

resultsOf 3,004 patients in the parent trial, we analyzed 2,404, including 1,821 vasopressor-first and 583 advanced airway-first. Median intervention times: ALS arrival-to-vasopressor 8 min (IQR 6-11) and ALS arrival-to-airway 11 min (8-15). Compared with airway-first, vasopressor-first sequence was not associated with 72-hour survival (adjusted OR 0.96; 95% CI: 0.71-1.31), ROSC (0.83; 0.66-1.06), hospital survival (1.09; 0.68-1.73), or hospital survival with favorable neurologic status (0.97; 0.53-1.78). Vasopressor-first sequence was not associated with non-compliance with recommended CPR performance parameters.

conclusionsVasopressor-airway resuscitation sequence was not associated with OHCA outcomes or CPR quality.

Indexed as

Airway ManagementCardiopulmonary ResuscitationOut-of-Hospital Cardiac ArrestVasoconstrictor AgentsAgedEpinephrineFemaleHumansIntubation, IntratrachealMaleMiddle AgedReturn of Spontaneous CirculationVasopressinsEpinephrineVasoconstrictor AgentsVasopressinsAirway managementCardiopulmonary arrestEpinephrineVasopressors

Identifiers

PMID39486473
PMCPMC12303251

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.