Abstract 9960: Does the Airway Management Device for Out-of-Hospital Cardiac Arrest Have No Effect to Patient’s Outcome?
Introduction: Supraglottic airway devices (SADs) and endotracheal tube (ET) are widely used for out-of-hospital cardiac arrest (OHCA) patients. However, it remains unclear whether SADs or ET are used on patients with worse conditions or not.
Hypothesis: The aim of this study was to assess the incidence of shockable rhythm in those on whom a bag valve mask (BVM), SADs and ET is used at the first contact of emergency medical services (EMS).
Methods: A total of 925288 OHCA patients from January 1, 2005 through December 31, 2012 in Japan’s nationwide registry were stidied. All OHCA data was collected according to the Utstein-style guidelines. We included adult patient (age from 15 to 89 years) with presumed cardiac origin, for whom the collapse was witnessed. We excluded epinephrine administration, non-cardiac origin, patients who regained return of spontaneous circulation before EMS arrival, and patients for whom the time exceeded a 99 percentile of EMS response time which is defined by EMS call-contact interval. The primary end point was shockable rhythm defined by initial ECG.
Cox’s proportional hazards regression model was used to test the significance of shockable rhythm adjusting for age, gender, airway management and EMS response time. Patient’s age was stratified into 4 groups as 15-49, 50-69, 70-79, 80-89 years of age. ANOVA was used to test the difference of EMS response time among airway management.
Results: A total of 80960 patients met the inclusion criteria, 42768 patients (53%) in the BVM group, 34062 patients (42%) in the SADs group and 4130 patients (5%) in the ET group. Adjusted hazard ratio compared to the BVM group was; 0.82 (95% CI 0.79-0.84) for the SADs group and 0.72 (95% CI 0.67-0.78) for the ET group. EMS mean response times +/- SEM were BVM:498.1 +/- 1.00 seconds, SADs: 511.1 +/- 1.12 seconds and ET:525.5 +/- 3.22 seconds (p<0.001).
Conclusions: In conclusion, SADs and ET are used when the incidence of shockable rhythm is lower and EMS response time is longer. Therefore, SADs or ET is used when the condition of patients is worse than BVM. We have to consider the patients’ medical status for analyzing the effectiveness of airway management devices.
Author Disclosures: H. Takyu: None. H. Tanaka: None. T. Nakagawa: None.
- © 2014 by American Heart Association, Inc.