Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients: A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial

Denise Battaglini¹, Irene Schiavetti², Lorenzo Ball³, Janus Christian Jakobsen⁴, Gisela Lilja⁵, Hans Friberg⁶, Pedro David Wendel-Garcia⁷, Paul J Young⁸, Glenn Eastwood⁹, Michelle S Chew¹⁰, Johan Unden¹¹, Matthew Thomas¹², Michael Joannidis¹³, Alistar Nichol¹⁴, Andreas Lundin¹⁵, Jacob Hollenberg¹⁶, Naomi Hammond¹⁷, Manoj Saxena¹⁸, Annborn Martin¹⁹, Miroslav Solar²⁰, Fabio Silvio Taccone²¹, Josef Dankiewicz²², Niklas Nielsen²³, Anders Morten Grejs²⁴, Matt P Wise²⁵, Matthias Hängghi²⁶, Ondrej Smid²⁷, Nicolò Patroniti³, Chiara Robba³; TTM2 trial investigators

Affiliations

¹ Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy. Electronic address: battaglini.denise@gmail.com.
² Department of Health Sciences, University of Genoa, Genova, Italy.
³ Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy.
⁴ Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
⁵ Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Sweden.
⁶ Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Lund, Sweden.
⁷ Institute of Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
⁸ Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand; Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Parkville, VIC, Australia.
⁹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Australia.
¹⁰ Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹¹ Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Operation and Intensive Care, Lund University, Hallands Hospital Halmstad, Halland, Sweden.
¹² University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
¹³ Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
¹⁴ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; University College Dublin-Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45 Gothenburg, Sweden.
¹⁶ Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
¹⁷ Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.
¹⁸ Critical Care Division and Department of Intensive Care Medicine, The George Institute for Global Health and St George Hospital Clinical School, University of New South Wales, Sydney, Australia.
¹⁹ Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
²⁰ Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic; Department of Internal Medicine-Cardioangiology, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
²¹ Department of Intensive Care Medicine, Université Libre de Bruxelles, Hopital Universitaire de Bruxelles (HUB), Brussels, Belgium.
²² Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
²³ Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden.
²⁴ Department of Intensive Care Medicine, Aarhus University Hospital, Denmark, Department of Clinical Medicine, Aarhus University, Denmark.
²⁵ Adult Critical Care, University Hospital of Wales, Cardiff, UK.
²⁶ Department of Intensive Care Medicine, Inselspital, Bern University Hospital University of Bern, Bern, Switzerland.
²⁷ 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague 2, Czech Republic.

PMID: 39244144
DOI: 10.1016/j.resuscitation.2024.110390

Randomized Controlled Trial

Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients: A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial

Denise Battaglini et al. Resuscitation. 2024 Oct.

. 2024 Oct:203:110390.

doi: 10.1016/j.resuscitation.2024.110390. Epub 2024 Sep 5.

Authors

Affiliations

¹ Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy. Electronic address: battaglini.denise@gmail.com.
² Department of Health Sciences, University of Genoa, Genova, Italy.
³ Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy.
⁴ Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
⁵ Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Sweden.
⁶ Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Lund, Sweden.
⁷ Institute of Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
⁸ Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand; Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Parkville, VIC, Australia.
⁹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Australia.
¹⁰ Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹¹ Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Operation and Intensive Care, Lund University, Hallands Hospital Halmstad, Halland, Sweden.
¹² University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
¹³ Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
¹⁴ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; University College Dublin-Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland.
¹⁵ Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45 Gothenburg, Sweden.
¹⁶ Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
¹⁷ Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.
¹⁸ Critical Care Division and Department of Intensive Care Medicine, The George Institute for Global Health and St George Hospital Clinical School, University of New South Wales, Sydney, Australia.
¹⁹ Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
²⁰ Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic; Department of Internal Medicine-Cardioangiology, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
²¹ Department of Intensive Care Medicine, Université Libre de Bruxelles, Hopital Universitaire de Bruxelles (HUB), Brussels, Belgium.
²² Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
²³ Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden.
²⁴ Department of Intensive Care Medicine, Aarhus University Hospital, Denmark, Department of Clinical Medicine, Aarhus University, Denmark.
²⁵ Adult Critical Care, University Hospital of Wales, Cardiff, UK.
²⁶ Department of Intensive Care Medicine, Inselspital, Bern University Hospital University of Bern, Bern, Switzerland.
²⁷ 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague 2, Czech Republic.

PMID: 39244144
DOI: 10.1016/j.resuscitation.2024.110390

Abstract

Introduction: Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients' outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality.

Methods: Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes.

Results: Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88-1.28, p = 0.54.

Conclusions: In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes.

Trial registration number: NCT02908308.

Keywords: Airway devices; Airway management; Cardiac arrest; Outcome, endotracheal intubation; Supraglottic device.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Fabio Silvio Taccone reports a relationship with Bard Medical that includes: funding grants. Fabio Silvio Taccone reports a relationship with ZOLL Medical Corporation that includes: funding grants. Manoj Saxena reports a relationship with Bard Medical that includes: consulting or advisory and speaking and lecture fees. Niklas Nielsen reports a relationship with Bard Medical that includes: consulting or advisory and speaking and lecture fees. Manoji Saxena reports a relationship with BrainCoo that includes: consulting or advisory and speaking and lecture fees. Niklas Nielsen reports a relationship with BrainCoo that includes: consulting or advisory and speaking and lecture fees. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper”.

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Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients: A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial

Affiliations

Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients: A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial

Authors

Affiliations

Abstract

Conflict of interest statement

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Associated data

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Full Text Sources

Medical