Abstract 112: Effect of Pre-Hospital Airway Management Method on Outcomes in Patients With Out-of-Hospital Cardiac Arrest
Background: Since July 2004, emergency medical service (EMS) personnel have been able to perform endotracheal intubation to patients who receive cardiopulmonary resuscitation (CPR) before arrival at the hospital in Japan. At present, there are 3 methods used for pre-hospital airway management in patients with out-of-hospital cardiac arrest (OHCA). It is therefore an optimal time to compare the outcomes of patients with OHCA according to the pre-hospital airway management.
Methods: An observational study was performed in 431,968 patients who had OHCA in Japan and received CPR between January 1, 2005 and December 31, 2008. Of these patients, 11,822 in whom age was from 15 to 75 years old, OHCA was cardiogenic, the scene of OHCA was witnessed, bystander CPR was performed, and spontaneous circulation did not return before arrival at the hospital were studied. The subjects were divided into 3 groups according to the method used for airway management by EMS: 5,398 who used a back-valve mask, 5,641 who used a supraglottic airway device, and 783 who underwent endotracheal intubation. The rates of favorable outcomes (CPC1–2) at various time points from the initiation of EMS CPR to arrival at the hospital were smoothed using propensity scores and spline functions. Multivariate logistic regression analysis was performed to examine effectiveness.
Results: The rate of favorable outcomes was highest in patients who used a back-valve mask among the 3 methods, regardless of the time from EMS CPR to hospital arrival (Figure). In particular, the rate of favorable outcomes in the back-valve mask group was two-fold or higher than that in either of the other two groups until first 12 minutes after the initiation of EMS CPR.
Conclusions: In patients with OHCA, the use of a back-valve mask for airway management increases the rate of favorable outcomes regardless of the time from EMS CPR to arrival at the hospital, particularly when the time until arrival at the hospital is less than 12 minutes.
- © 2010 by American Heart Association, Inc.