Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Abstract

IntroductionBoth supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.MethodsAll adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.ResultsOf 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P < 0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.ConclusionsThere was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.

Part 7: Adult Advanced Cardiovascular Life Support

“…50,54,[56][57][58]61 Several retrospective observational studies show more favorable outcome with the use of an SGA device, whereas other studies favor the use of endotracheal intubation. 47,49,50,[59][60][61] 2015 Recommendations-Updated Either a bag-mask device or an advanced airway may be used for oxygenation and ventilation during CPR in both the inhospital and out-of-hospital setting (Class IIb, LOE C-LD).…”

Nationwide Improvements in Survival From Out-of-Hospital Cardiac Arrest in Japan

“…Recently, some studies suggested that earlier epinephrine administration and earlier endotracheal intubation contributed to improving outcomes after OHCA. 25,26 Further elaborate studies that consider the timing of the procedure or the patient's rhythm are needed to confirm the effect of ALS measures.…”

Aspirations- und Pneumonierisiko nach präklinischer invasiver Beatmung

“…Zu diesem Thema existieren mehrere große retrospektive Studien [24][25][26][27][28]. Problematisch bei der Beurteilung der Relevanz dieser zahlenmäßig enorm großen Studien sind die unterschiedlichen Einschlusskriterien und insbesondere die unterschiedlichen Rettungsdienstsysteme.…”