Abstract 297: Efficacy of Ventilation with the Laryngeal Tube During Out-of-Hospital Cardiopulmonary Resuscitation
BACKGROUND: Airway management in cardiac arrest victims is a challenging ambition. The preclinical use of a supraglottic airway device, the laryngeal tube, also known as King LT, is currently on the rise. The aim of this study was to investigate the efficacy of successful ventilation during ongoing cardiopulmonary resuscitation via laryngeal tube in comparison to endotracheal intubation.
MATERIALS AND METHODS: This retrospective cohort-study was based on the cardiac-arrest-registry of our emergency department. We included out-of-hospital cardiac arrest patients of non-traumatic origin between 2008 and 2012, ventilated by laryngeal-tube or endotracheal-tube during ongoing resuscitation. Primary outcome was quality of ventilation. SpO2, SaO2, and paO2 served as outcome measure of adequate oxygenation. EtCO2, paCO2, and pH-value, from first obtained arterial blood-gas-analysis at admission, were used to measure ventilation performance. Secondary outcome was 6-month-survival and neurologic recovery (CPC 1 or 2). Data are presented as median and inter-quartile-range (IQR).
RESULTS: Included were 80 patients, ventilated via laryngeal-tube and 405 patients receiving endotracheal intubation. SpO2 was significantly higher after conventional intubation (97%[IQR87-100] vs. 93%[IQR83-100], p=0.02). EtCO2 did not differ significantly. The pH-value was lower in the laryngeal-tube-group (7.002[IQR 6.907-7.121]) compared to endotracheal intubation (7.103[IQR 6.940-7.228]), p<0.01), just as SaO2 (laryngeal tube: 95.9%[IQR 80.3-98.4] vs. endotracheal tube: 97.2%[IQR 88-99], p=0.02). PaCO2 was significantly higher with laryngeal-tube ventilation (8.27kPa[IQR 6.29-11.17]) than endotracheal ventilation (6.62kPa[IQR 5.56-8.46] p<0.01). Survival with neurologic recovery did not differ between the airway groups.
CONCLUSION: Cardiac arrest victims ventilated via a laryngeal-tube presented with lower SpO2, pH and SaO2 and higher levels of paCO2 at hospital admission. Differences in admission blood-gas-analysis between the two airway-devices did not reflect in outcome of our patients. Further prospective trials are needed to assess ventilation and oxygenation success of supraglottic airway-devices for cardiac arrest victims.
Author Disclosures: P. Stratil: None. C. Testori: None. C. Wallmüller: None. A. Schober: None. T. Uray: Research Grant; Significant; Laerdal Foundation for Acute Medicine, Max Kade Foundation, Inc.. F. Sterz: None.
- © 2014 by American Heart Association, Inc.