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Comparative Study
. 2012 Sep;83(9):1061-6.
doi: 10.1016/j.resuscitation.2012.05.018. Epub 2012 Jun 1.

Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest

Henry E Wang  1 , Daniel Szydlo, John A Stouffer, Steve Lin, Jestin N Carlson, Christian Vaillancourt, Gena Sears, Richard P Verbeek, Raymond Fowler, Ahamed H Idris, Karl Koenig, James Christenson, Anushirvan Minokadeh, Joseph Brandt, Thomas Rea; ROC Investigators
Affiliations
Comparative Study

Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest

Henry E Wang et al. Resuscitation. 2012 Sep.

Abstract

Objective: To simplify airway management and minimize cardiopulmonary resuscitation (CPR) chest compression interruptions, some emergency medical services (EMS) practitioners utilize supraglottic airway (SGA) devices instead of endotracheal intubation (ETI) as the primary airway adjunct in out-of-hospital cardiac arrest (OHCA). We compared the outcomes of patients receiving ETI with those receiving SGA following OHCA.

Methods: We performed a secondary analysis of data from the multicenter Resuscitation Outcomes Consortium (ROC) PRIMED trial. We studied adult non-traumatic OHCA receiving successful SGA insertion (King Laryngeal Tube, Combitube, and Laryngeal Mask Airway) or successful ETI. The primary outcome was survival to hospital discharge with satisfactory functional status (Modified Rankin Scale ≤3). Secondary outcomes included return of spontaneous circulation (ROSC), 24-h survival, major airway or pulmonary complications (pulmonary edema, internal thoracic or abdominal injuries, acute lung injury, sepsis, and pneumonia). Using multivariable logistic regression, we studied the association between out-of-hospital airway management method (ETI vs. SGA) and OHCA outcomes, adjusting for confounders.

Results: Of 10,455 adult OHCA, 8487 (81.2%) received ETI and 1968 (18.8%) received SGA. Survival to hospital discharge with satisfactory functional status was: ETI 4.7%, SGA 3.9%. Compared with successful SGA, successful ETI was associated with increased survival to hospital discharge (adjusted OR 1.40; 95% CI: 1.04, 1.89), ROSC (adjusted OR 1.78; 95% CI: 1.54, 2.04) and 24-h survival (adjusted OR 1.74; 95% CI: 1.49, 2.04). ETI was not associated with secondary airway or pulmonary complications (adjusted OR 0.84; 95% CI: 0.61, 1.16).

Conclusions: In this secondary analysis of data from the multicenter ROC PRIMED trial, ETI was associated with improved outcomes over SGA insertion after OHCA.

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Conflict of interest statement

Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Adjusted associations of out-of-hospital advanced airway (ETI vs. SGA) with survival to hospital discharge with satisfactory functional status (Modified Rankin Scale ≤3), 24-h survival, return of spontaneous circulation (ROSC) and secondary airway and pulmonary complications. Analysis includes full cohort (n = 10,455) for survival to hospital discharge, 24-h survival, and ROSC, and partial cohort (n = 2564) for secondary airway and pulmonary complications. Full models listed in Appendices 2–4. ETI = endotracheal intubation. SGA = supraglottic airway.
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References

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