Abstract 104: Prehospital Advanced Airway Management with a Decreased Chance of Neurologically Favorable Survival for Out-of-Hospital Cardiac Arrest: A Prospective, Nationwide, Population-Based Cohort Study
Introduction It is unclear whether prehospital advanced airway management, such as endotracheal intubation and supraglottic airways, is associated with improved out-of-hospital cardiac arrest (OHCA) outcomes compared with conventional bag-valve-mask ventilation (BMV).
Hypothesis We tested the hypothesis that any type of prehospital advanced airway management is associated with favourable neurological outcome after adult OHCA.
Methods Prospective, nation-wide, population-based, observational study using the All-Japan Utstein Registry involving all adult OHCA patients across Japan from January 2005 through December 2010. The primary endpoint was favourable neurological outcome 1 month after an OHCA, defined as Cerebral Performance Category 1 or 2. We compared the outcome between each airway management group using multivariable logistic regression. We repeated the analysis using propensity-matched subsets.
Results Of eligible 649 359 OHCA patients, 367 837 (57%) were managed with BMV, 41 972 (6%) with endotracheal intubation and 239 550 (37%) with supraglottic airways. Using the full cohort, the advanced airway group had a significantly lower rate of favourable neurological outcome compared to the BMV group (1.1% vs. 2.9%; OR 0.38; 95% CI 0.36-0.39). In the models adjusting for a predefined set of confounders, chance of neurologically favourable survival was significantly lower both for endotracheal intubation (adjusted OR 0.41; 95% CI 0.37-0.45) and for supraglottic airways (adjusted OR 0.38; 95% CI 0.36-0.40). Using propensity-matched cohort, chance of neurologically favourable survival was significantly lower both for endotracheal intubation (adjusted OR 0.45; 95% CI 0.37-0.55; Figure) and for supraglottic airways (adjusted OR 0.36; 95% CI 0.33-0.39).
Conclusion Among adult OHCA patients, any type of advanced airway management was independently associated with a decreased chance of neurologically favourable survival compared to BMV.
- © 2012 by American Heart Association, Inc.