Abstract 314: Risk of Aspiration and Early-Onset Pneumonia After Emergency Ventilation: A Comparison of Laryngeal Tube and Endotracheal Intubation
Introduction: Laryngeal tubes (LT) have substantially facilitated emergency airway management. Currently, the LT shows increasing use. However, it remains unclear whether LT provides comparable protection against aspiration or not even higher rates of aspiration and pneumonia, compared to endotracheal intubation (ET) as former gold standard.
Hypothesis: LT are not associated with higher rates of pulmonary aspiration
Methods: Retrospective analysis for aspiration and early-onset pneumonia in patients (pts) after preclinical airway management by either LT or ET. Further, in-hospital mortality was analyzed.
Results: 90 pts with ventilation by either ET (n= 69) or LT (n=21) were included in the study. Pts were not included if indication for ventilation was pneumonia, aspiration, drowning or if they had preexisting tracheotomy. ET and LT-group did not differ regarding age (ET: 62±16 yrs, LT: 64±8 yrs, p=0.56), female gender (ET: 23.2%, LT: 33.3%, p=0.25), or first paO2/FiO2 (ET: 300±164, LT: 342±178, p=0.3). The majority of pts were survivors of out-of-hospital cardiac arrest (OHCA, 72.2%), with a significant higher OHCA-rate in the LT-group (LT: 95.2% ET: 65.2%, p = 0.006).
Analysis for pulmonary aspiration revealed a higher aspiration rate in the ET-group (43.5%, LT: 23.8%, p = 0.08), especially after OHCA (ET: 48.9%, LT: 20%, p=0.025).
In parallel, early-onset pneumonia as correlate for microaspiration was observed more frequent in ET-pts (41% vs. 25%, p= 0.21). In OHCA-patients without aspiration, rates of pneumonia were similar (ET: 26.1%, LT: 25%; p=0.62).
Analysis of in-hospital mortality showed a significant higher mortality in the LT-group (57.1% vs 30.4%, p=0.026). Also in OHCA-pts, higher mortality was observed in the LT-group (60% vs. 28.9%, p=0.018). By multivariate analysis for in-hospital mortality, only a low first pH was identified as independent predictor of death (HR 0.064, 95% CI 0.006-0.635, p=0.019).
Conclusions: Airway management by LT was not associated with higher risk of aspiration. In contrast, higher rates of aspiration and pneumonia were observed after ET, especially in OHCA-pts. However, a prognostic impact of LT remains to be elucidated.
- Emergency care
- Cardiopulmonary resuscitation
- Post cardiac resuscitation
- Post cardiac arrest care
- Advanced life support
Author Disclosures: J. Honold: None. J. Hodrius: None. T. Schwietz: None. A. Zeiher: None. F. Seeger: None.
- © 2014 by American Heart Association, Inc.