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Mechanisms linking advanced airway management and cardiac arrest outcomes.

ABSTRACT: Advanced airway management--such as endotracheal intubation (ETI) or supraglottic airway (SGA) insertion--is one of the most prominent interventions in out-of-hospital cardiac arrest (OHCA) resuscitation. While randomized controlled trials are currently in progress to identify the best advanced airway technique in OHCA, the mechanisms by which airway management may influence OHCA outcomes remain unknown. We provide a conceptual model describing potential mechanisms linking advanced airway management with OHCA outcomes.

SUBMITTER: Benoit JL

PROVIDER: S-EPMC4506864 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Mechanisms linking advanced airway management and cardiac arrest outcomes.

Benoit Justin L JL Prince David K DK Wang Henry E HE

Resuscitation 20150611

Advanced airway management--such as endotracheal intubation (ETI) or supraglottic airway (SGA) insertion--is one of the most prominent interventions in out-of-hospital cardiac arrest (OHCA) resuscitation. While randomized controlled trials are currently in progress to identify the best advanced airway technique in OHCA, the mechanisms by which airway management may influence OHCA outcomes remain unknown. We provide a conceptual model describing potential mechanisms linking advanced airway manage ...[more]

PMID: 26073275

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Project description:BackgroundTrans-nasal evaporative cooling is an effective method to induce intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest (OHCA). The use of supraglottic airway devices (SGA) instead of endotracheal intubation may enable shorter time intervals to induce cooling. We aimed to study the outcomes in OHCA patients receiving endotracheal intubation (ETI) or a SGA during intra-arrest trans-nasal evaporative cooling.MethodsThis is a pre-specified sub-study of the PRINCESS trial (NCT01400373) that included witnessed OHCA patients randomized during resuscitation to trans-nasal intra-arrest cooling vs. standard care followed by temperature control at 33 °C for 24 h. For this study, patients randomized to intra-arrest cooling were stratified according to the use of ETI vs. SGA prior to the induction of cooling. SGA was placed by paramedics in the first-tier ambulance or by physicians or anesthetic nurses in the second tier while ETI was performed only after the arrival of the second tier. Propensity score matching was used to adjust for differences at the baseline between the two groups. The primary outcome was survival with good neurological outcome, defined as cerebral performance category (CPC) 1-2 at 90 days. Secondary outcomes included time to place airway, overall survival at 90 days, survival with complete neurologic recovery (CPC 1) at 90 days and sustained return of spontaneous circulation (ROSC).ResultsOf the 343 patients randomized to the intervention arm (median age 64 years, 24% were women), 328 received intra-arrest cooling and had data on the airway method (n = 259 with ETI vs. n = 69 with SGA). Median time from the arrival of the first-tier ambulance to successful airway management was 8 min for ETI performed by second tier and 4 min for SGA performed by the first or second tier (p = 0.001). No significant differences in the probability of good neurological outcome (OR 1.43, 95% CI 0.64-3.01), overall survival (OR 1.26, 95% CI 0.57-2.55), full neurological recovery (OR 1.17, 95% CI 0.52-2.73) or sustained ROSC (OR 0.88, 95% CI 0.50-1.52) were observed between ETI and SGA.ConclusionsAmong the OHCA patients treated with trans-nasal evaporative intra-arrest cooling, the use of SGA was associated with a significantly shorter time to airway management and with similar outcomes compared to ETI.

Project description:Background The timing of advanced airway management (AAM) on patient outcomes after out-of-hospital cardiac arrest has not been fully investigated. We evaluated the association between the timing of prehospital AAM and 1-month survival. Methods and Results We conducted a secondary analysis of a prospective, nationwide, population-based out-of-hospital cardiac arrest registry in Japan. We included emergency medical services-treated adult (≥18 years) out-of-hospital cardiac arrests from 2014 through 2017, stratified into initial shockable or nonshockable rhythms. Patients who received AAM at any minute after emergency medical services-initiated cardiopulmonary resuscitation underwent risk-set matching with patients who were at risk of receiving AAM within the same minute using time-dependent propensity scores. Eleven thousand three hundred six patients with AAM in shockable and 163 796 with AAM in nonshockable cohorts, respectively, underwent risk-set matching. For shockable rhythms, the risk ratios (95% CIs) of AAM on 1-month survival were 1.01 (0.89-1.15) between 0 and 5 minutes, 1.06 (0.98-1.15) between 5 and 10 minutes, 0.99 (0.87-1.12) between 10 and 15 minutes, 0.74 (0.59-0.92) between 15 and 20 minutes, 0.61 (0.37-1.00) between 20 and 25 minutes, and 0.73 (0.26-2.07) between 25 and 30 minutes after emergency medical services-initiated cardiopulmonary resuscitation. For nonshockable rhythms, the risk ratios of AAM were 1.12 (1.00-1.27) between 0 and 5 minutes, 1.34 (1.25-1.44) between 5 and 10 minutes, 1.39 (1.26-1.54) between 10 and 15 minutes, 1.20 (0.99-1.45) between 15 and 20 minutes, 1.18 (0.80-1.73) between 20 and 25 minutes, 0.63 (0.29-1.38) between 25 and 30 minutes, and 0.44 (0.11-1.69) after 30 minutes. Conclusions In this observational study, the timing of AAM was not statistically associated with improved 1-month survival for shockable rhythms, but AAM within 15 minutes after emergency medical services-initiated cardiopulmonary resuscitation was associated with improved 1-month survival for nonshockable rhythms.

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Mechanisms linking advanced airway management and cardiac arrest outcomes.

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Mechanisms linking advanced airway management and cardiac arrest outcomes.

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