Abstract 303: Did the Difficult Airway Influence Outcome After Out-of-Hospital Cardiac Arrest? A German Register-Based Study
Background: [[Unable to Display Character:  ]]Airway management during resuscitation is pivotal for treating hypoxia. For securing the airway endotracheal intubation is the gold standard. The German Resuscitation Registry analysis investigates the influence of airway management on primary outcomes after out-of-hospital cardiac arrest, in a physician-based two tired emergency medical system. The German Resuscitation Registry was founded in 2007. It is a voluntary registry and covers a population about 20 mio inhibitants. Up to May 2014 45.000 cases are included in the registry.
Methods: [[Unable to Display Character:  ]]A total of 8.512 patients recorded in the German Resuscitation Registry (2007-2011) were analyzed. The Return of Spontaneous Circulation After Cardiac Arrest (RACA)(2) score was used to compare observed return of spontaneous circulation (ROSC) rates with the ROSC predicted by the score and to analyze factors influencing the primary outcome. Patients were classified into three groups: difficult intubation, impossible intubation, and a control group with normal airways.
Results: [[Unable to Display Character:  ]]The observed ROSC matched the predicted ROSC in the groups with difficult airways and normal airways. The impossible intubation group had lower ROSC rates (31.3% vs. 40.5%,(P < 0.05)). Impossible intubation was more frequent in men (OR 0.44; 95% CI, 0.28-0.70), young patients (OR 0.46; 95% CI, 0.27-0.79) and those with trauma (OR 0.45; 95% CI, 0.21-0.99). Fewer impossible intubations were reported when the emergency physicians were anesthesiologists (OR 1.54; 95% CI, 1.05-2.27). If a supraglottic airway device was not used, the observed ROSC (18.0%; 95% CI, 7.4%-28.6%) was poorer than predicted (38.2%). In the difficult intubation group the observed ROSC rate was 44.1% in comparison to the predicted ROSC rate of 41.3% (n.s.).
Conclusions: [[Unable to Display Character:  ]]Outcomes after resuscitation are poorer when endotracheal intubation is not possible. Predictive factors for impossible intubation are male gender, younger age, and trauma. Supraglottic airway devices should be used at an early stage whenever these negative factors are present. Training in airway management as well as team training is essential in advanced life support.
Author Disclosures: J. Wnent: None. R. Franz: None. R. Lefering: None. J. Walther: None. S. Seewald: None. M. Fischer: None. T. Jantzen: None. M. Messelken: None. A. Bohn: None. J. Gräsner: Speakers Bureau; Modest; Weinmann Medical Germany.
- © 2014 by American Heart Association, Inc.