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Comparative Study
. 2011;15(5):R236.
doi: 10.1186/cc10483. Epub 2011 Oct 10.

Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Kentaro Kajino  1 , Taku Iwami, Tetsuhisa Kitamura, Mohamud Daya, Marcus Eng Hock Ong, Tatsuya Nishiuchi, Yasuyuki Hayashi, Tomohiko Sakai, Takeshi Shimazu, Atsushi Hiraide, Masashi Kishi, Shigeru Yamayoshi
Affiliations
Comparative Study

Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Kentaro Kajino et al. Crit Care. 2011.

Abstract

Introduction: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.

Methods: All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.

Results: Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P < 0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.

Conclusions: There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.

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Figures

Figure 1
Figure 1
Out-of-hospital cardiac arrest cases for analysis. EMS, emergency medical services; SGA, supraglottic airway devices; ETI, endotracheal intubation.
Figure 2
Figure 2
Multivariate-adjusted odds ratios for neurologically favorable survival. SGA, supraglottic airway devices; ETI, endotracheal intubation; ELST, emergency Life-Saving Technicians; CPR, cardiopulmonary resuscitation; VF, ventricular fibrillation.
Figure 3
Figure 3
Odds ratios of favorable neurological outcome by quartile time of advanced airway management. OR, odds ratio; CIs, confidence intervals.
See this image and copyright information in PMC

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References

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