[Aspiration and pneumonia risk after preclinical invasive resuscitation: Endotracheal intubation and supraglottic airway management with the laryngeal tube S]

Abstract

Background: Laryngeal tubes (LT) have substantially facilitated emergency airway management. However, it remains unclear whether LTs provide comparable protection against aspiration or even higher rates of aspiration and pneumonia compared to endotracheal intubation (ET) as the former gold standard.

Methods: The indices for aspiration and early onset pneumonia in patients after preclinical airway management by either LT or ET were retrospectively analyzed. Furthermore, in-hospital mortality was analyzed.

Results: A total of 90 patients with invasive ventilation by either ET (n = 69) or LT (n = 21) were analyzed. Patients were excluded if indication for ventilation was pneumonia, aspiration, drowning, or if they had preexisting tracheotomy. The ET and LT groups did not differ regarding age (ET: 62 ± 16 years, LT: 64 ± 8 years, 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 patients were survivors of out-of-hospital cardiac arrest (OHCA, 72.2%), with a significantly higher OHCA rate in the LT group (LT: 95.2% ET: 65.2%, p = 0.006). Analysis for radiological or endoscopic evidence of 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 a correlate for microaspiration in patients without evident aspiration was observed more frequently in ET patients (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 significantly higher mortality in the LT group (57.1% vs 30.4%, p = 0.026). Also in OHCA patients, higher mortality was observed in the LT group (60 vs. 28.9%, p = 0.018).

Discussion and conclusion: 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 patients. However, a possible prognostic impact of supraglottic airway devices remains to be elucidated.

Keywords: Airway management, out-of-hospital; Cardiopulmonary resuscitation; Hospital mortality; Macroaspiration; Pneumonia, ventilator-associated.