ROC, paper, scissors: Tracheal intubation or supraglottic airway for out-of-hospital cardiac arrest?

Resuscitation ◽  
2012 ◽  
Vol 83 (9) ◽  
pp. 1047-1048 ◽  
Author(s):  
David C. Cone ◽  
Paul M. Middleton
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Supraglottic Airway ◽  
Hospital Cardiac Arrest

Abstract 164: Comparison of Tracheal Intubation vs. Supraglottic Airway Following Pediatric Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Maryam Y Naim ◽  
Heather Griffis ◽  
Robert A Berg ◽  
Richard N Bradley ◽  
Matthew L Hansen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Cerebral Performance Category ◽  
Supraglottic Airway ◽  
Secondary Outcome ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: There are few data comparing Tracheal Intubation (TI) and SupraGlottic Airway (SGA) following pediatric out of hospital cardiac arrest (OHCA). Hypothesis: TI is associated with improved outcomes compared to SGA following pediatric OHCA. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by Emergency Medical Services (EMS). To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and initial rhythm. Primary outcome was neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Secondary outcome was survival to hospital discharge. Results: Of 2653 cardiac arrests evaluated, 2178 (82.1%) had TI and 475 (17.9%) had SGA placed during OHCA. 835 (31.2%) arrests were resuscitated by agencies used bag valve mask (BVM) and TI and 1818 (68.0%) arrests had agencies that used all 3 airway types (BVM/TI/SGA). Overall, unadjusted favorable neurological survival was 5.7% for TI and 5.3% for SGA, p=0.67 and survival to hospital discharge was 7.9% for TI and 7.5% for SGA, p=0.73. In multivariable analysis (adjusting for age, sex, race/ethnicity, bystander witness, bystander CPR, initial rhythm, AED use, year of arrest, and agency category), SGA was associated with lower neurologically favorable survival compared to TI (adjusted proportion 3.7% vs. 6.3%, OR 0.49, p=0.01), and lower survival to hospital discharge (5.5% vs. 8.5%, OR 0.57, 95% CI 0.36, 0.89). These results were robust on tests for unmeasured confounding and covariate balance; propensity analysis neurologically favorable survival 4.4% vs.7.6% (OR 0.54, 95% CI 0.30, 0.96), survival to hospital discharge 6.6% vs.10.5% (OR 0.58, 95% CI 0.35, 0.95); and entropy balance neurologically favorable survival 5.0 % vs. 9.7% for ETI (OR 0.44, 95% CI 0.27, 0.72), survival to hospital discharge 7.3% vs.12.5% (OR 0.51, 95% CI 0.34, 0.78). Conclusion: In pediatric OHCA, TI, compared with SGA advanced airway management is associated with improved neurologically favorable survival and survival to hospital discharge.

scholarly journals Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome

JAMA ◽  
2018 ◽  
Vol 320 (8) ◽  
pp. 779 ◽  
Author(s):  
Jonathan R. Benger ◽  
Kim Kirby ◽  
Sarah Black ◽  
Stephen J. Brett ◽  
Madeleine Clout ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Functional Outcome ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device ◽  
Hospital Cardiac Arrest

Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis

Resuscitation ◽  
2015 ◽  
Vol 93 ◽  
pp. 20-26 ◽  
Author(s):  
Justin L. Benoit ◽  
Ryan B. Gerecht ◽  
Michael T. Steuerwald ◽  
Jason T. McMullan
Keyword(s):  
Cardiac Arrest ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Supraglottic Airway ◽  
Hospital Cardiac Arrest

scholarly journals Blood gas phenotyping and tracheal intubation timing in adult in-hospital cardiac arrest: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chih-Hung Wang ◽  
Meng-Che Wu ◽  
Cheng-Yi Wu ◽  
Chien-Hua Huang ◽  
Min-Shan Tsai ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Interaction Analysis ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Optimal Time ◽  
Hypercapnic Acidosis ◽  
Blood Gas ◽  
Regression Analyses ◽  
Hospital Cardiac Arrest

AbstractTo investigate whether the optimal time to tracheal intubation (TTI) during cardiopulmonary resuscitation would differ by different blood gas phenotypes. Adult patients experiencing in-hospital cardiac arrest (IHCA) from 2006 to 2015 were retrospectively screened. Early intra-arrest blood gas analysis, performed within 10 min of resuscitation, was used to define different phenotypes. In total, 567 patients were included. Non-severe acidosis (pH≧7.15) was associated with favourable neurological outcome (odds ratio [OR]: 4.60, 95% confidence interval [CI] 1.63–12.95; p value = 0.004) and survival (OR: 3.25, 95% CI 1.72–6.15; p value < 0.001) in the multivariable logistic regression analyses. In the interaction analysis, normal blood gas phenotype (pH: 7.35–7.45, PCO2: 35–45 mm Hg, HCO3− level: 22–26 mmol/L) × TTI ≦ 6.3 min (OR: 20.40, 95% CI 2.53–164.75; p value = 0.005) and non-severe acidosis × TTI ≦ 6.3 min (OR: 3.35, 95% CI 1.00–11.23; p value = 0.05) were associated with neurological recovery while metabolic acidosis × TTI ≦ 5.7 min (OR: 3.63, 95% CI 1.36–9.67; p value = 0.01) and hypercapnic acidosis × TTI ≦ 10.4 min (OR: 2.27, 95% CI 1.20–4.28; p value = 0.01) were associated with survival. Intra-arrest blood gas analysis may help guide TTI during for patients with IHCA.

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