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. 2025 Apr 15:23:100957.
doi: 10.1016/j.resplu.2025.100957. eCollection 2025 May.

Evaluation of the optimal timing for advanced airway management for adult patients with out-of-hospital cardiac arrest: A retrospective observational study from a multicenter registry

Yuki Kishihara  1 , Shunsuke Amagasa  2 , Hideto Yasuda  1   3   4   5 , Masahiro Kashiura  1 , Yutaro Shinzato  1 , Takashi Moriya  1
Affiliations

Evaluation of the optimal timing for advanced airway management for adult patients with out-of-hospital cardiac arrest: A retrospective observational study from a multicenter registry

Yuki Kishihara et al. Resusc Plus. .

Abstract

Aim: We aimed to investigate the appropriate timing for advanced airway management (AAM) in witnessed adult non-traumatic out-of-hospital cardiac arrest (OHCA) by adjusting for resuscitation time bias and limiting the analysis to witnessed OHCA.

Methods: This retrospective observational study used a multicentre OHCA registry involving 99 participating hospitals in Japan and included adult patients with witnessed non-traumatic OHCA who underwent AAM during resuscitation. The primary and secondary outcomes were favourable 30-day neurological outcomes and survival, respectively. The time from emergency medical service contact to AAM was categorised as follows: 1-5, 6-10, 11-15, 16-20, 21-25, and 26-30 min. In each group, we calculated the time-dependent propensity score using a Fine-Gray regression model. After propensity score matching, we used a generalised estimating equation (GEE).

Results: A total of 16,448 patients who underwent AAM were matched with patients at risk of requiring AAM. AAM was associated with favourable 30-day neurological outcomes when performed at 6-10 and 16-20 min with RRs (95% CIs) of 1.41 (1.12-1.78), but not at 16-20 min (0.74 [0.56-0.99]), respectively. AAM was associated with improved 30-day survival at 1-5 and 6-10 min (1.22 [1.05-1.41], 1.33 [1.16-1.54], respectively), but not at 16-20 min (0.78 [0.62-0.97].

Conclusions: Performing AAM within 10 min was associated with improved outcomes compared with those at risk of receiving AAM. However, the results were not consistent across all groups, therefore, careful interpretation is required.

Keywords: Airway management; Cardiopulmonary resuscitation; Emergency medical services; Intubation, intratracheal; Out-of-hospital cardiac arrest.

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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.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Flowchart of the screening and enrolment process within the current study. Abbreviations: AAM, advanced airway management; EMS, emergency medical service; OHCA, out-of-hospital cardiac arrest.
Fig. 2
Fig. 2
The 30-day favourable neurological outcome stratified by the timing of AAM. Abbreviations: AAM, advanced airway management.
Fig. 3
Fig. 3
Thirty-day survival stratified by the timing of AAM. Abbreviations: AAM, advanced airway management.
See this image and copyright information in PMC

References

    1. Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. 2020 Mar 3;141:e139–596. 10.1161/CIR.0000000000000757. Epub 2020 Jan 29. - DOI - PubMed
    1. Gräsner J.T., Lefering R., Koster R.W., et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016;105:188–195. - PubMed
    1. Benoit J.L., Prince D.K., Wang H.E. Mechanisms linking advanced airway management and cardiac arrest outcomes. Resuscitation. 2015;93:124–127. - PMC - PubMed
    1. Kurz M.C., Prince D.K., Christenson J., et al. Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest. Resuscitation. 2016;98:35–40. - PubMed
    1. Kajino K., Iwami T., Kitamura T., et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care. 2011;15:R236. - PMC - PubMed

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