Abstract P32: Impact Of Supraglottic Airways And Endotracheal Intubation On Outcomes Following Witnessed Out-of-hospital Cardiac Arrest
Introduction: The benefit of advanced airway management including a supraglottic airway (SGA) and endotracheal intubation (ETI) for out-of-hospital cardiac arrest (OHCA) remains to be determined.
Purpose: The aim of this study was to evaluate the effect of advanced airway placement on the survival from witnessed OHCA.
Materials and methods: We enrolled all persons aged 18 years or older who suffered OHCA of presumed cardiac etiology that was witnessed by bystanders and received advanced airway management by emergency medical service (EMS) in Osaka Prefecture (8.8 million), Japan from January 2005 through December 2007. Emergency Life Saving Technicians (ELSTs) were permitted to use a SGA (Combitube, LMA, LMT and Sumiway tube®) from 2001 and specially trained ELSTs were trained in ETI in 2004. Data were prospectively collected by EMS personnel using an Utstein-style database. The primary outcome was one-month survival with favorable neurological outcome. Multiple logistic regression was used to evaluate the relationship between confounding variables (age, gender, location, bystander CPR, adrenaline use, ESLT’s status, ETI use, presenting rhythm, and response time) and outcome.
Results: Of 3,570 witnessed cardiac arrests of presumed cardiac etiology, 2,700 cases received advanced airway management. Among the 2,700, 641 cases (23.7%) had an ETI while 2,029 cases (75.1%) had a SGA placed. Neurologically favorable one-month survival was similar in both the ETI group and the SGA group (29 [4.5%] versus 77 [3.8%]; p=0.412). After adjusting for confounding variables, ETI was not associated with better outcome (OR=0.59; 95% CI, 0.24 –1.47; p=0.24). However, the delay time to advanced airway management was a significant predictor of neurologically favorable survival (OR=0.91; 95% CI, 0.86 – 0.96; p<0.001) for each one minute delay in airway placement.
Conclusion: Early placement of an advanced airway regardless of the type improves outcome from witnessed adult OHCA.