Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 28:20:100813.
doi: 10.1016/j.resplu.2024.100813. eCollection 2024 Dec.

Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest

Olaf Aretz  1   2 , Jana Vienna Rödler  1 , Athina Gavriil  3 , Marc Deussen  4 , Emmanuel Chorianopoulos  3 , Sebastian Bergrath  1   2
Affiliations

Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest

Olaf Aretz et al. Resusc Plus. .

Abstract

Aim: Guidelines recommend supraglottic airways (e.g. laryngeal tube, LT) for out-of-hospital cardiac arrest (OHCA) if providers are not skilled in endotracheal intubation (ETI). In prolonged cardiopulmonary resuscitation (CPR) LT led to asphyxial physiology. Therefore we evaluated the impact of LT vs. ETI on gasometry and lactate at admission.

Methods: All patients from 1 January 2020 to 30 April 2023 with return of spontaneous circulation (ROSC) or ongoing CPR (no ROSC) were included in this retrospective cohort study.Continuous data were analysed using the Mann-Whitney-U-Test.

Results: Overall, 147 patients were included: ETI, n = 104; LT, n = 33; other airways, n = 10. ROSC, n = 86; no ROSC, n = 61. ETI vs. LT (median) for all patients showed: arterial blood gas analyses (BGA) (n = 62 vs. n = 20): pH 7.01 vs. 7.07, p = 0.83; pCO2 64.5 vs. 66.6 mmHg, p = 0.62; lactate 10.1 vs. 9.5 mmol/l, p = 0.68. Venous BGA (n = 37 vs. n = 11): pH 6.91 vs. 7.12, p = 0.15; pCO2 77.4 vs. 66.0 mmHg, p = 0.19; lactate 11.5 vs. 8.6 mmol/l, p = 0.24. ROSC, arterial BGA (n = 39 vs. n = 12): pH 7.09 vs. 7.14, p = 0.36; pCO2 60.3 vs. 56.4 mmHg, p = 0.84; lactate 8.95 vs. 7.0 mmol/l, p = 0.35. No ROSC, arterial BGA (n = 23 vs. n = 8): pH 6.9 vs. 6.8, p = 0.03; pCO2 80.7 vs. 85.6 mmHg, p = 0.64; lactate 13.0 vs. 14.6 mmol/l, p = 0.62.

Conclusion: The prehospital airway strategy had no impact on gasometry in this OHCA collective except a better pH with ETI in no ROSC. Due to small numbers and non-existent data about the exact prehospital ventilation parameters, further prospective studies are needed to evaluate this question.

Keywords: Endotracheal intubation; Gasometry; Laryngeal tube; Out-of-hospital cardiac arrest; Physiology.

PubMed Disclaimer

Conflict of interest statement

The 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. Parts of the results were presented as a poster on the German Interdisciplinary Emergency medicine Congress, March 2024, Koblenz, Germany.

Figures

Fig. 1
Fig. 1
Study flow chart. CPR, cardiopulmonary resuscitation; ETI, endotracheal intubation; LT, laryngeal tube; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation; SGA, supraglottic airway device.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Soar J., Böttiger B.W., Carli P., et al. European Resuscitation Council Guidelines 2021: adult advanced life support. Resuscitation. 2021;161:115–151. doi: 10.1016/j.resuscitation.2021.02.010. - DOI - PubMed
    1. Berg K.M., Soar J., Andersen L.W., et al. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(16_suppl_1):S92–S139. doi: 10.1161/CIR.0000000000000893. - DOI - PubMed
    1. Nolan J.P., Sandroni C., Böttiger B.W., et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021;47(4):369–421. doi: 10.1007/s00134-021-06368-4. - DOI - PMC - PubMed
    1. Benger J.R., Kirby K., Black S., et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial. J Am Med Assoc. 2018;320(8):779–791. doi: 10.1001/jama.2018.11597. - DOI - PMC - PubMed
    1. Jabre P., Penaloza A., Pinero D., et al. Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest: a randomized clinical trial. J Am Med Assoc. 2018;319(8):779–787. doi: 10.1001/jama.2018.0156. - DOI - PMC - PubMed

LinkOut - more resources