Supraglottic Airway Devices Versus Endotracheal tube for Out of Hospital Cardiac Arrest by Propensity Score Analysis in Japan Utstein Registry

Resuscitation ◽  
2012 ◽  
Vol 83 ◽  
pp. e16
Author(s):  
Hiroshi Takyu ◽  
Takashi Nakagawa ◽  
Akinori Takeuchi ◽  
Yoshihirro Hanaki ◽  
Hiroshi Kaneko ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Endotracheal Tube ◽  
Propensity Score Analysis ◽  
Supraglottic Airway ◽  
Score Analysis ◽  
Supraglottic Airway Devices ◽  
Airway Devices ◽  
Hospital Cardiac Arrest

Abstract 13226: Epinephrine versus Norepinephrine in Cardiac Arrest Patients With Postresuscitation Shock

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Wulfran Bougouin ◽  
Kaci Slimani ◽  
Marie Renaudier ◽  
Yannick Binois ◽  
Marine Paul ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Analysis ◽  
Controlled Trial ◽  
Cerebral Performance Category ◽  
Multivariate Regression Analysis ◽  
Sensitivity Analyses ◽  
Score Analysis ◽  
Hospital Cardiac Arrest

Backgound: Whether epinephrine or norepinephrine is preferable as the continuous intravenous vasopressor used to treat postresuscitation shock is unclear. Objectives: To compare outcomes of patients with postresuscitation shock after out-of-hospital cardiac arrest according to whether the continuous intravenous vasopressor used was epinephrine or norepinephrine. Methods: We conducted an observational multicenter study of consecutive patients managed in 2011-2018 for postresuscitation shock. The primary outcome was all-cause hospital mortality, and secondary outcomes were cardiovascular hospital mortality and unfavorable neurological outcome (Cerebral Performance Category 3 to 5). A multivariate regression analysis and a propensity score analysis were performed, as well as several sensitivity analyses. Results: Of the 766 patients included in five hospitals, 285 (37%) received epinephrine and 481 (63%) norepinephrine. All-cause hospital mortality was significantly higher in the epinephrine group (OR 2.6; 95%CI, 1.4-4.7; P =0.002). Cardiovascular hospital mortality was also higher with epinephrine (aOR 5.5; 95%CI 3.0-10.3; P <0.001), as was the proportion of patients with CPC of 3 to 5 at hospital discharge. Sensitivity analyses produced consistent results. The analysis involving adjustment on a propensity score to control for confounders showed similar findings (aOR 2.1; 95%CI 1.1-4.0; P =0.02). Conclusions: Among patients with postresuscitation shock after out-of-hospital cardiac arrest, use of epinephrine was associated with higher all-cause and cardiovascular-specific mortality, compared with norepinephrine infusion. A randomized controlled trial comparing the two vasopressors in this population is warranted.

scholarly journals Impact of cooling method on the outcome of initial shockable or non-shockable out of hospital cardiac arrest patients receiving target temperature management: a nationwide multicentre cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Makoto Watanabe ◽  
Tasuku Matsuyama ◽  
Hikaru Oe ◽  
Makoto Sasaki ◽  
Yuki Nakamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score Analysis ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Multivariable Logistic Regression Analysis ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Score Analysis ◽  
Hospital Cardiac Arrest ◽  
Cooling Methods

Abstract Background Little is known about the effectiveness of surface cooling (SC) and endovascular cooling (EC) on the outcome of out-of-hospital cardiac arrest (OHCA) patients receiving target temperature management (TTM) according to their initial rhythm. Methods We retrospectively analysed data from the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest registry, a multicentre, prospective nationwide database in Japan. For our analysis, OHCA patients aged ≥ 18 years who were treated with TTM between June 2014 and December 2017 were included. The primary outcome was 30-day survival with favourable neurological outcome defined as a Glasgow–Pittsburgh cerebral performance category score of 1 or 2. Cooling methods were divided into the following groups: SC (ice packs, fans, air blankets, and surface gel pads) and EC (endovascular catheters and any dialysis technique). We investigated the efficacy of the two categories of cooling methods in two different patient groups divided according to their initially documented rhythm at the scene (shockable or non-shockable) using multivariable logistic regression analysis and propensity score analysis with inverse probability weighting (IPW). Results In the final analysis, 1082 patients were included. Of these, 513 (47.4%) had an initial shockable rhythm and 569 (52.6%) had an initial non-shockable rhythm. The proportion of patients with favourable neurological outcomes in SC and EC was 59.9% vs. 58.3% (264/441 vs. 42/72), and 11.8% (58/490) vs. 21.5% (17/79) in the initial shockable patients and the initial non-shockable patients, respectively. In the multivariable logistic regression analysis, differences between the two cooling methods were not observed among the initial shockable patients (adjusted odd ratio [AOR] 1.51, 95% CI 0.76–3.03), while EC was associated with better neurological outcome among the initial non-shockable patients (AOR 2.21, 95% CI 1.19–4.11). This association was constant in propensity score analysis with IPW (OR 1.40, 95% CI 0.83–2.36; OR 1.87, 95% CI 1.01–3.47 among the initial shockable and non-shockable patients, respectively). Conclusion We suggested that the use of EC was associated with better neurological outcomes in OHCA patients with initial non-shockable rhythm, but not in those with initial shockable rhythm. A TTM implementation strategy based on initial rhythm may be important.

scholarly journals Use of supraglottic airway devices by paramedics in the management of adult prehospital cardiac arrest patients.

2017 ◽  
Vol 14 (1) ◽  
Author(s):  
Stephen Barr ◽  
Gavin Smith ◽  
Shaunagh Darroch
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Best Practice ◽  
Current Evidence ◽  
Cochrane Library ◽  
Supraglottic Airway ◽  
Next Generation ◽  
Supraglottic Airway Devices ◽  
Airway Devices ◽  
Prehospital Cardiac Arrest

IntroductionCurrent best practice for paramedic airway management of prehospital cardiac arrest is being continually reviewed following changes to the emphasis on intubation as a primary intervention within international resuscitation guidelines. Subsequently, there is increased enthusiasm for the use of next generation supraglottic airway devices. This review aimed to identify the current evidence for the safety and effectiveness of supraglottic airways for the management of prehospital cardiac arrest. MethodsA search of the electronic databases Medline, PubMed, Science Direct and Cochrane Library was conducted. Papers were excluded if they did not examine airway management in the prehospital cardiac arrest setting, involved the use of sedative or paralysing agents, involved paediatric patients, animals or cadavers. ResultsOf the 689 articles identified, 22 peer-reviewed articles were included for analysis. All 22 articles were from the following countries: America (3), America and Canada (1), Australia (2), Austria (1), Finland (1), Germany (4), Korea (1), Japan (4), The Netherlands (1), Norway (1), Taiwan (1), and United Kingdom (2). DiscussionThis review revealed large variances in both device effectiveness and patient outcome, particularly between geographical locations. Second-generation supraglottic airway devices demonstrated considerable improvement in effectiveness over their predecessors. Interestingly, the use of bag-valve mask ventilation reported better outcomes than any other form of advanced airway intervention. Studies also highlighted the diversity of airway management techniques and devices across global EMS systems. ConclusionDespite favourable indications of the effectiveness and safety of the next generation supraglottic airway devices, the paucity of prehospital-specific research (particularly randomised controlled trials) challenges decision making regarding prehospital airway management best practice.

scholarly journals Comparison of Safety and Efficacy of Endotracheal Tube, Laryngeal Mask Airway Supreme and I Gel in Laparoscopic Surgeries

2021 ◽  
Vol 8 (11) ◽  
pp. 623-628
Author(s):  
Heena Saini ◽  
Rajesh Angral ◽  
Neelam Gupta
Keyword(s):  
Laryngeal Mask Airway ◽  
Endotracheal Tube ◽  
Gastric Tube ◽  
Airway Device ◽  
Laryngeal Mask ◽  
Supraglottic Airway ◽  
Group I ◽  
Supraglottic Airway Devices ◽  
Lma Supreme ◽  
Airway Devices

BACKGROUND Present study was undertaken to assess the feasibility of laryngeal mask airway (LMA) supreme and I gel, the second generation supraglottic airway devices in laparoscopic surgeries. METHODS 120 patients with American Society of Anaesthesiologists (ASA) I and II (20 - 50 years) of either sex who underwent laparoscopic surgery under general anaesthesia were randomly divided into three groups. Airway was secured with endotracheal tube (ETT) in group E (N = 40), with LMA supreme in Group S (N = 40) and with I-gel in group I (N = 40). Insertion characteristics of airway device, ease of gastric tube insertion, haemodynamic response and perioperative laryngopharyngeal morbidities were assessed. RESULTS I-gel was easier to insert with higher first attempt success rate (95 %) than LMA Supreme (85 %) and ETT (90 %) but it was statistically insignificant. Heart rate (HR) and mean arterial pressure (MAP) was significantly higher in ETT group at the time of intubation, continued till 5 minutes and also at the time of extubation but statistically significant increase in HR and MAP were noted in group S and I only at the time of device insertion. Gastric tube was easier to insert in group S with shortest insertion time which was statistically significant. Incidence of coughing, dysphonia, dysphagia and sore throat was significantly more in group E. CONCLUSIONS I-gel and LMA Supreme can be used as an alternative to ETT for airway management in adult patients undergoing elective laparoscopic surgeries. KEYWORDS Endotracheal Tube, I-gel, LMA Supreme, Supraglottic Airway Device

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