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68 Poster Presentations / Res

dvanced Life SupportP114

omparison of intraosseous versus central venous vascularccess in adults under resuscitation in the emergency depart-ent with inaccessible peripheral veins

ernd A. Leidel 1,∗, Chlodwig Kirchhoff 2, Viktoria Bogner 2, Volkerraunstein 2, Peter Biberthaler 2, Karl-Georg Kanz 2

Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin,nterdisziplinäreRettungsstelle und Aufnahmestation, Berlin, GermanyKlinikum der UniversitätMünchen, ChirurgischeKlinik und PoliklinikInnenstadt, München, Germany

Purpose of the study: Current European Resuscitation Coun-il (ERC) guidelines recommend intraosseous (IO) vascular access,f intravenous (IV) access is not readily available. Because cen-ral venous catheterisation (CVC) is an established alternative forn-hospital resuscitation, we compared IO access versus landmark-ased CVC in adults with difficult peripheral veins.

Methods: In this prospective observational study we investi-ated success rates on first attempt and procedure times of IOccess versus central venous catheterisation (CVC) in adults (≥18ears of age) with inaccessible peripheral veins under trauma oredical resuscitation in a level I trauma centre emergency depart-ent.Results: Forty consecutive adults under resuscitation were ana-

ysed, each receiving IO access and CVC simultaneously. Successates on first attempt were significantly higher for IO cannulationhan CVC (85% versus 60%, p = 0.024) and procedure times were sig-ificantly lower for IO access compared to CVC (2.0 versus 8.0 min,< 0.001). As for complications, failure of IO access was observed inpatients, while 2 or more attempts of CVC were necessary in 16atients. No other relevant complications like infection, bleedingr pneumothorax were observed.

Conclusions: IO vascular access is a reliable bridging methodo gain vascular access for in-hospital adult patients under resusci-ation with difficult peripheral veins. Moreover, IO access is morefficacious with a higher success rate on first attempt and a lowerrocedure time compared to landmark-based CVC.

ttp://dx.doi.org/10.1016/j.resuscitation.2012.08.173

P115

oes adrenaline in OOHCA make the wrong kind of difference?bservations from the Irish OHCAR data

iobhan Maguire 1,∗, Siobhan Masterson 2, Akke Vellinge 3, Niamhollins 4

AMNCH, Dublin, IrelandOHCAR, HSE West, Letterkenny, IrelandSchool of Medicine, NUIG, Galway, IrelandJCMH, Dublin, Ireland

Purpose of the study: Recent studies have come to light whichuestion the effectiveness of adrenaline on survival in out-of-ospital cardiac arrest. Irish OOHCA registry data was studied toxamine the effect of adrenaline on ROSC and survival to discharge.

Methods: A retrospective, observational study was carried outn Irish out-of-hospital cardiac arrest registry data. The studyeriod was 02/11/07 to 29/02/2012. Patients were 18 yrs or older,

ith non-traumatic, out-of-hospital cardiac arrests. Our outcomeeasures were return of spontaneous circulation (ROSC) at any

tage, ROSC on arrival, survival to hospital discharge and CPC (Cere-ral Performance Category) score on discharge.

tion 83 (2012) e24–e123

A propensity score analysis was performed to account for nonrandom allocation of adrenaline and to confirm the results from thefull population.

In total 1650 patients were included in the analysis.Results: ROSC at any stage was observed in 186 out of 802

patients (23.2%) of the adrenaline group and 138 out of 814 patients(18.4%) in the no-epinephrine group. ROSC on arrival to hospitalwas observed in 117 out of 385 (30.4%) patients in the adrenalinegroup and 120 out of 341 patients (35.2%) in the no-adrenalinegroup.

With our data we can’t conclude any positive or negative cor-relation between pre-hospital adrenaline and ROSC. Adjusted ORfor ROSC at any stage and ROSC on arrival are 0.8 (0.4–1.4) and 0.5(0.2–1.1).

However a negative association was observed with pre-hospitaladrenaline use and long term survival. Adjusted OR with adrenalineof survival was 0.1 (0.0–0.1) and death was 8.0 (4.0–16.6). Similarnegative associations were observed among propensity matchedpatients (adjusted ORs: survival to hospital discharge 0.1 (0.1–0.2)and death 8.7 (4.2–18.3).

Conclusion: In patients with OOHCA in Ireland pre hospital useof adrenaline is associated with a decreased chance of survival tohospital discharge.

Further reading

].Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospitalepinephrine use and survival among patients with out of hospital cardiac arrest.JAMA 2012;307:1161–8.

].Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L. Intravenousdrug administration duting out-of-hospital cardiac arrest: a randomized trial.JAMA 2009;302:2222–9.

].Olasveengen TM, Wik L, Sunde K, Steen PA. Outcome whenadrenaline(epinephrine) was actually given vs not given- post hoc analysisof a randomized trial. Resuscitation 2012;83:327–32.

].Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline onsurvival in out-of-hospital cardiac arrest: a randomised double-blind placebocontrolled trial. Resuscitation 2011;82:1138–43.

http://dx.doi.org/10.1016/j.resuscitation.2012.08.174

AP116

Clinical outcome of Extracorporeal CardiopulmonaryResuscitation—10 year experience from hyogo emergencymedical center

Ryusuke Miki 1,∗, Haruki Nakayama 1, Nobuaki Igarashi 1, ShinichiNakayama 1, Tomohumi Doi 2, Shuichi Kozawa 2

1 Hyogo Emergency Medical Center, Kobe City, Hyogo, Japan2 Japanese Redcross Society Kobe Hospital, Kobe City, Hyogo, Japan

Purpose: To evaluate the efficacy of Extracorporeal Cardiopul-monary Resuscitation (ECPR) using clinical neurological outcome.

Methods: Out of hospital cardiac arrest patients who were stillin cardiac arrest in any rhythm on arrival and underwent emer-gent extracorporeal cardiopulmonary bypass from 2003 to 2012were included in this retrospective single center analysis. Traumapatients were excluded. Total of 49 patients were identified andevaluated on three clinical neurological outcome categories: 1. neu-rologically intact, 2. vegetative state or brain death, 3. death. Thetime from collapse to induction of percutaneous cardiopulmonarysupport (PCPS) on each category were compared. Clinical neurolog-ical outcome based on initial rhythm, rhythm on arrival, and typeof disease were analyzed. The lengths of hospital stay in patients

with each outcome were also compared.

Results: Of 49 patients, 14 patients (29%) were neurologicallyintact, 11 patients (22%) were either vegetative state or brain death,24 patients (49%) were dead on discharge. The average time from