Time to invasive airway placement and resuscitation outcomes after inhospital cardiopulmonary arrest

Abstract

Background-Clinicians often place high priority on invasive airway placement during cardiopulmonary resuscitation. The benefit of early versus later invasive airway placement remains unknown. In this study we examined the association between time to invasive airway (TTIA) placement and patient outcomes after inhospital cardiopulmonary arrest (CPA).

Part 8: Adult Advanced Cardiovascular Life Support

“…In a registry study of 25 006 in-hospital cardiac arrests, earlier time to invasive airway (Ͻ5 minutes) was not associated with improved ROSC but was associated with improved 24-hour survival. 31 In an urban out-of-hospital setting, intubation that was achieved in Ͻ12 minutes was associated with better survival than intubation achieved in Ն13 minutes. 32 In out-of-hospital urban and rural settings, patients intubated during resuscitation had a better survival rate than patients who were not intubated, 33 whereas in an in-hospital setting, patients who required intubation during CPR had a worse survival rate.…”

“…32 In a registry study of 25 006 in-hospital cardiac arrests, earlier time to advanced airway (Ͻ5 minutes) was not associated with increased ROSC but was associated with improved 24-hour survival. 31 In out-of-hospital urban and rural settings, patients intubated during resuscitation had better survival rates than patients who were not intubated. 33 In an in-hospital setting patients requiring intubation during CPR had worse survival rates.…”

“…Frequent experience or frequent retraining is recommended for providers who perform endotracheal intubation (Class I, LOE B). 31,66 EMS systems that perform prehospital intubation should provide a program of ongoing quality improvement to minimize complications (Class IIa, LOE B).…”

Part 8: Advanced Life Support

“…80 In this study, earlier time to invasive airway (Ͻ5 minutes) was associated with no improvement in ROSC but improved 24-hour survival (NNTϭ48). In an urban out-of-hospital setting, intubation in Ͻ12 minutes was associated with better survival than intubation Ն13 minutes.…”

Advances in Resuscitation

“…For in-hospital SCD, intubation within 5 minutes (compared with intubation performed Ͼ5 minutes after arrest) has been associated with either worse outcome or a slight increase in 24-hour survival without increased ROSC. 85,86 Out-of-hospital data are more heterogeneous: Both intubation (regardless of timing) and intubation within 12 minutes have been associated with improved survival in retrospective studies. 87,88 On the other hand, studies assessing minimally interrupted cardiac resuscitation and passive ventilation suggest that intubation may not be advantageous.…”