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. 2022 Dec:62:89-95.
doi: 10.1016/j.ajem.2022.10.010. Epub 2022 Oct 13.

The association of delayed advanced airway management and neurological outcome after out-of-hospital cardiac arrest in Japan

Koshi Nakagawa  1 , Ryo Sagisaka  2 , Daigo Morioka  3 , Shota Tanaka  4 , Hiroshi Takyu  5 , Hideharu Tanaka  6
Affiliations

The association of delayed advanced airway management and neurological outcome after out-of-hospital cardiac arrest in Japan

Koshi Nakagawa et al. Am J Emerg Med. 2022 Dec.

Abstract

Introduction: The effectiveness of advanced airway management (AAM) for out-of-hospital cardiac arrest (OHCA) has been reported differently in each region; however, no study has accounted for the regional differences in the association between the timing of AAM implementation and neurological outcomes.

Objective: This study aimed to evaluate the association between the timing of patient or prefecture level AAM and a favorableneurological outcome defined by cerebral performance category 1 or 2 (CPC 1-2).

Methods: A retrospective cohort study was conducted using data from the All-Japan Utstein Registry between 2013 and 2017. We included patients aged ≥8 years with OHCA for whom AAM (i.e., supraglottic airway or endotracheal intubation) was performed in a prehospital setting (n = 182,913). We divided the patients into shockable (n = 11,740) and non-shockable (n = 171,173) cohorts based on the initial electrocardiogram rhythm. Multilevel logistic regression analysis estimated the association between AAM time (patient contact-to-AAM performance interval) at the patient level (1-min unit increments), prefecture level (> 9.2 min vs. ≤ 9.2 min) and CPC 1-2.

Results: A delay in AAM time was negatively associated with CPC 1-2 (adjusted odds ratio [AOR], 0.92, 0.96; 95% confidence interval [CI], 0.90-0.93, 0.95-0.97, respectively), regardless of initial rhythm. At the prefecture level, a delay in AAM time was negatively associated with CPC 1-2 (AOR, 0.77, 0.68; 95% CI, 0.58-1.04, 0.50-0.94, respectively) only in the non-shockable cohort.

Conclusion: A delay in AAM performance was negatively associated with CPC 1-2 in both shockable and non-shockable cohorts. Moreover, a delay in AAM performance at the prefecture level was negatively associated with CPC 1-2 in the non-shockable cohort.

Keywords: Advanced airway management; Advanced life support; Multilevel analysis; Out-of-hospital cardiac arrest; Prehospital care.

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Conflict of interest statement

Declaration of Competing Interest All authors declare that they have no competing interests.