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In non-traumatic out of hospital cardiac arrest (OHCA), administration of an initial dose of IM epinephrine by EMS prior to an established IV or IO was associated with improved survival outcomes. 

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Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. Epub 2024 Jun 9. PMID: 38857847.

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Dynamic increases in continuous end-tidal CO₂ (EtCO₂) were associated with increased odds of return of spontaneous circulation (ROSC) for patients with out-of-hospital cardiac arrest (OHCA), but EtCO₂ trended down in patients who did not achieve ROSC.

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Temporal Trends in End-Tidal Capnography and Outcomes in Out-of-Hospital Cardiac Arrest: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024;7(7):e2419274. doi:10.1001/jamanetworkopen.2024.19274. PMID: 38967927.

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Attempting initial vascular access in the field by intraosseous (IO) vs. intravenous (IV) route made no difference in survival to hospital discharge for out-of-hospital cardiac arrest (OHCA), despite greater IO success rates.

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Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial). BMJ. 2024 Jul 23:386:e079878. doi: 10.1136/bmj-2024-079878. PMID: 39043416.

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In a retrospective study of 142 patients with an initial shockable rhythm and 4 to 5 episodes of recurrent/refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), shorter duration of VF and pVT was associated with higher rates of ROSC. 

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The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms. Resuscitation. 2024;201:110286. doi:10.1016/j.resuscitation.2024.110286. PMID: 38901663.

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This systematic review and meta-analysis of 43 nonrandomized studies over 30 years looking at termination of resuscitation (TOR) rules in out of hospital cardiac arrest (OHCA) found that there was insufficient evidence to support widespread implementation of TOR rules in clinical practice, as this may lead to missed survivors.

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Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024 Jul 1;7(7):e2420040. doi: 10.1001/jamanetworkopen.2024.20040. PMID: 38958975; PMCID: PMC11222995.

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Back blows outperformed abdominal thrusts and chest compressions in successful clearance of out-of-hospital foreign body airway obstructions (FBAO).

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Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study. Resuscitation. 2024 Aug;201:110258. doi: 10.1016/j.resuscitation.2024.110258. Epub 2024 May 31. PMID: 38825222.

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Prehospital providers tend to underestimate the time to ED arrival for EMS ground transports.

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Accuracy of Prehospital Services' Estimated Time to Arrival for Ground Transport to the Emergency Department. J Emerg Med. 2024 May;66(5):e581-e588. doi: 10.1016/j.jemermed.2023.12.010. Epub 2023 Dec 14. PMID: 38553364.

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In a large retrospective review of patients with out-of-hospital-cardiac-arrest (OHCA) there was a very small, and probably clinically insignificant, association with favorable neurological outcome and survival in those who underwent early as opposed to late advanced airway management. 

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Early versus late advanced airway management for adult patients with out-of-hospital cardiac arrest: A time-dependent propensity score matched analysis. Acad Emerg Med. 2024 Apr 8. Epub ahead of print. DOI: 10.111/acem.14907

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A retrospective study of 60 patients who received a fixed-dose ketamine of 250 mg by EMS observed that 6 were intubated in the ED. There was no association between weight-based dose of ketamine and risk for intubation.

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Fixed dose ketamine for prehospital management of hyperactive delirium with severe agitation. Am J Emerg Med. Published online April 9, 2024. doi:10.1016/j.ajem.2024.04.011

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In subgroup analysis, there may be more successful ROSC in patients with upper extremity IO access compared to lower extremity access in OHCA, but these results should be adopted with caution.

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Retrospective Comparison of Upper and Lower Extremity Intraosseous Access During Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2024 Mar 26:1-8. doi: 10.1080/10903127.2024.2321285. Epub ahead of print. PMID: 38416867.