Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan

Abstract

Objective: This retrospective study was designed to determine the choice of airway devices used for nontraumatic, out-of-hospital cardiac arrest patients and to evaluate the success and failure of insertion and airway control/ventilation by three airway adjuncts, the Combitube, the esophageal gastric tube airway (EGTA), and the laryngeal mask (LM), which were used in conjunction with the bag-valve-mask (BVM) by emergency life-saving technicians (ELSTs) in Japan.

Methods: A survey of 1,085 ELSTs was performed to identify the type of airway devices, the success rates of airway insertion, the effectiveness of airway control/ventilation in comparison with the BVM prior to each airway insertion, and associated complications. The type of education for airway skills was also surveyed.

Results: 1,079 surveys were returned and 12,020 cases of cardiac arrest were studied. Choice of airway devices: BVM, 7,180 cases; EGTA, 545 cases; Combitube, 1,594 cases; and LM, 2,701 cases. Successful insertion rates on the first attempt: EGTA, 82.7%; Combitube, 82.4%; and LM, 72.5% (p < 0.0001). Failed insertions: EGTA, 8.2%; Combitube, 6.9%; and LM, 10.5% (p < 0.0001). Successful ventilation: EGTA, 71.0%; Combitube, 78.9%; and LM, 71.5% (p < 0.0004). Six cases of aspiration were reported in the LM group, whereas nine cases of soft-tissue injuries, including esophageal perforation, were reported in the Combitube group. 17.8% had vomited either prior or during airway placement.

Conclusion: The Combitube appears to be the most appropriate choice among the airway devices examined. However, serious injuries to the tissues, though they rarely occurred in the study, remain a major concern.