Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome

Benger, Jonathan; Kirby, Kim; Black, Sarah; Brett, Stephen; Clout, Madeleine; Lazaroo, Michelle; Nolan, Jerry P.; Reeves, Barnaby C; Robinson, Maria; Scott, Lauren J; Smartt, Helena J.M.; South, Adrian; Stokes, Elizabeth A; Taylor, Jodi; Thomas, Matthew; Voss, Sarah; Wordsworth, Sarah; Rogers, Chris

doi:10.1001/jama.2018.11597

Cited by 350 publications

(290 citation statements)

References 32 publications

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“…Based on the variability of individual intubation experience among paramedics in this single EMS, the results cannot be transferred to another EMS. Furthermore, our study was conducted over 4 years and there has possibly been an increase in SGA use by paramedics, because more recent studies indicated that SGAs could be equivalent or better than ETI [28,29]. This might have also an effect on the small number of cases in the whole investigation period.…”

Section: Limitationsmentioning

confidence: 99%

Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study

et al. 2020

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Background: Videolaryngoscopy (VL) has become a popular method of intubation (ETI). Although VL may facilitate ETI in less-experienced rescuers there are limited data available concerning ETI performed by paramedics during CPR. The goal was to evaluate the impact VL compared with DL on intubation success and glottic view during CPR performed by German paramedics. We investigated in an observational prospective study the superiority of VL by paramedics during CPR compared with direct laryngoscopy (DL). Methods: In a single Emergency Medical Service (EMS) in Germany with in total 32 ambulances paramedics underwent an initial instruction from in endotracheal intubation (ETI) with GlideScope® (GVL) during resuscitation. The primary endpoint was good visibility of the glottis (Cormack-Lehane grading 1/2), and the secondary endpoint was successful intubation comparing GVL and DL. Results: In total n = 97 patients were included, n = 69 with DL (n = 85 intubation attempts) and n = 28 VL (n = 37 intubation attempts). Videolaryngoscopy resulted in a significantly improved visualization of the larynx compared with DL. In the group using GVL, 82% rated visualization of the glottis as CL 1&2 versus 55% in the DL group (p = 0.02). Despite better visualization of the larynx, there was no statistically significant difference in successful ETI between GVL and DL (GVL 75% vs. DL 68.1%, p = 0.63). Conclusions: We found no difference in Overall and First Pass Success (FPS) between GVL and DL during CPR by German paramedics despite better glottic visualization with GVL. Therefore, we conclude that education in VL should also focus on insertion of the endotracheal tube, considering the different procedures of GVL.

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Section: Limitationsmentioning

confidence: 99%

Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study

et al. 2020

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“…In the ED, up to 40% of intubations were carried out in patients with cardiac arrest . Although the best intubation strategy during cardiopulmonary resuscitation (CPR) has not been established, intubation is considered the definitive method to secure the airway . However, the conditions unique to this population, for example, continuous chest compression during CPR and regurgitation, successful emergency airway management is a challenge.…”

Section: Special Circumstance: Cardiac Arrestmentioning

confidence: 99%

Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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“…In this paper, we summarize the rationale for, results of, and lessons from the Pragmatic Airway Resuscitation Trial (PART), the AIRWAYS-2 trial, and the Cardiac Arrest Airway Management (CAAM) trial. [6][7][8]…”

Section: Introductionmentioning

confidence: 99%

Endotracheal intubation during out‐of‐hospital cardiac arrest: New insights from recent clinical trials

Wang

Benger

2019

JACEP Open

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Airway management is an important intervention during resuscitation of out‐of‐hospital cardiac arrest (OHCA). Endotracheal intubation is commonly used by emergency medical services paramedics in the advanced airway management of OHCA, but numerous studies question its safety and effectiveness. Furthermore, there is now increasing use of supraglottic airway devices. In this review, we provide an overview of 3 recent randomized clinical trials of advanced airway management (Pragmatic Airway Resuscitation Trial [PART], AIRWAYS‐2, and Cardiac Arrest Airway Management [CAAM]) and highlight new information that is available to guide OHCA airway management practices.

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Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome

Abstract: ISRCTN Identifier: 08256118.

Cited by 350 publications

References 32 publications

Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study

Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study

Advancing emergency airway management practice and research

Endotracheal intubation during out‐of‐hospital cardiac arrest: New insights from recent clinical trials

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