Abstract 52: Comparison of Endotracheal Tube Intubation and King Airway Placement During Out-of-Hospital Cardiac Arrest
Background: Endotracheal tube intubation (ETI) has been the mainstay of airway management during out-of-hospital cardiac arrest (OHCA) for decades. In recent years, supraglottic airway devices have been introduced and adopted widely by many Emergency Medical System (EMS) services. Supraglottic devices such as the King airway can be placed rapidly with minimal interruption of ongoing chest compressions. Although prior studies have documented failure rates associated with ETI, there is limited information on the failure rate associated with the King airway in the prehospital setting.
Objective: To compare the performance of ETI and placement of the King supraglottic airway during OHCA.
Methods: The prehospital records of OHCA patients (n = 151) containing timelines and narratives were studied retrospectively. EMS personnel were permitted by protocol to use either type of device as the primary airway during OHCA. Crews were also instructed to use the alternative airway or revert to Bag-Valve Mask (BVM) ventilation in the event of a perceived failure with one of the devices. Details regarding type of airway used, airway placement attempts, and self-reported success rates were abstracted from the records. The Fisher Exact two-tailed probability test was used for p-value computation.
Results: Of the 47 cases in which a King airways was placed initially, 91% were reported by EMS to be successful. This was significantly higher (p = 0.0058) then the 71% success rate reported with 104 initial ETI attempts. Including both initial and all subsequent attempts following failures or dislodgements, there were a total of 202 placement attempts. Of these, the King airway was used in 63 attempts with an overall success rate of 90%. Again, this was significantly higher (p = 0.0012) than ETI which was used in 139 attempts of which 70% were successful. Four successful ETI placements subsequently became dislodged while no successful King placements became dislodged. Only two patients did not have a successful ETI or King airway placement and required the use of BVM ventilation.
Conclusion: Compared with ETI, the King airway had a significantly higher self-reported initial and overall success rate with no instances of dislodgment during OHCA.
- © 2010 by American Heart Association, Inc.