Abstract 105: Optimal Timing of Endotracheal Intubation Improves Survival in Out-of-Hospital-Cardiac Arrest Resuscitation
INTRODUCTION: Endotracheal intubation in out-of-hospital cardiac arrest (OHCA) patients remains controversial. Prehospital intubation may have detrimental effects on patient outcomes; however, the optimal timing of prehospital intubation as it relates to patient outcome is unclear.
HYPOTHESIS: In OHCA patients, post-return of spontaneous circulation (post-ROSC) intubation will be associated with improved survival to hospital discharge compared to pre-ROSC intubation in the prehospital setting.
METHODS: A retrospective cohort study of consecutive adult OHCA of presumed cardiac etiology treated by emergency medical services (EMS) between January 1, 2007 to June 30, 2010. EMS-witnessed and non-cardiac etiology OHCA were excluded.. The outcome was survival to hospital discharge. Univariate analyses were performed on the key independent variable, timing of intubation to ROSC, and the outcome. A multivariable logistic regression analysis was performed adjusting for core Utstein variables.
RESULTS: A total of 5,928 OHCA cases were eligible; 1,636 cases had a ROSC in the prehospital setting and 1,229 received endotracheal intubation. Those who received prehospital intubation had a lower rate of survival to hospital discharge compared to those who were not intubated (15.4% vs. 36.9%, p<0.0001). Post-ROSC intubation had a higher rate of survival to hospital discharge compared to pre-ROSC intubation (33.3% vs. 11.3%, p<0.0001). The adjusted odds ratio for post-ROSC intubation on survival to hospital discharge was 3.17 (95% CI: 2.09-4.81). There was no difference between the rates of survival to hospital discharge between post-ROSC intubation and no intubation (34.1% vs. 36.9%, p=0.53).
CONCLUSIONS: Intubation post-ROSC was associated with increased survival to hospital discharge, similar to rates of survival in OHCA patients who were resuscitated without intubation. This survival advantage may be attributed to fewer interruptions during CPR that result from the intubation process. This data may help address knowledge gaps identified in the current OHCA resuscitation guidelines.
- © 2011 by American Heart Association, Inc.