Airway management during in-hospital cardiac arrest in adults: UK national survey and interview study with anaesthetic and intensive care trainees

Background The optimal airway management strategy for in-hospital cardiac arrest is unknown. Methods An online survey and telephone interviews with anaesthetic and intensive care trainee doctors identified by the United Kingdom Research and Audit Federation of Trainees. Questions explored in-hospital cardiac arrest frequency, grade and specialty of those attending, proportion of patients receiving advanced airway management, airway strategies immediately available, and views on a randomised trial of airway management strategies during in-hospital cardiac arrest. Results Completed surveys were received from 128 hospital sites (76% response rate). Adult in-hospital cardiac arrests were attended by anaesthesia staff at 40 sites (31%), intensive care staff at 37 sites (29%) and a combination of specialties at 51 sites (40%). The majority (123/128, 96%) of respondents reported immediate access to both tracheal intubation and supraglottic airways. A bag-mask technique was used ‘very frequently’ or ‘frequently’ during in-hospital cardiac arrest by 111/128 (87%) of respondents, followed by supraglottic airways (101/128, 79%) and tracheal intubation (69/128, 54%). The majority (60/100, 60%) of respondents estimated that ≤30% of in-hospital cardiac arrest patients undergo tracheal intubation, while 34 (34%) estimated this to be between 31% and 70%. Most respondents (102/128, 80%) would be ‘likely’ or ‘very likely’ to recruit future patients to a trial of alternative airway management strategies during in-hospital cardiac arrest. Interview data identified several barriers and facilitators to conducting research on airway management in in-hospital cardiac arrest. Conclusions There is variation in airway management strategies for adult in-hospital cardiac arrest across the UK. Most respondents would be willing to take part in a randomised trial of airway management during in-hospital cardiac arrest.

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Variation in Out-of-Hospital Cardiac Arrest Management

Advances in Emergency Medicine ◽

10.1155/2016/6813718 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jason M. Jones ◽

Joseph A. Tyndall ◽

Christine M. Van Dillen

Keyword(s):

Cardiac Arrest ◽

Airway Management ◽

Prehospital Care ◽

Management Strategies ◽

Retrospective Chart Review ◽

Airway Device ◽

Care Providers ◽

One Airway ◽

Time And Energy ◽

Hospital Cardiac Arrest

Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA). Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%]), and one-quarter underwent three or more attempts (25/77 [25%]). One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]). Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

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Effect of airway management strategies during resuscitation from out-of-hospital cardiac arrest on clinical outcome: A registry-based analysis

Resuscitation ◽

10.1016/j.resuscitation.2020.04.015 ◽

2020 ◽

Vol 152 ◽

pp. 157-164

Author(s):

Niels-Henning Behrens ◽

Matthias Fischer ◽

Tobias Krieger ◽

Kathleen Monaco ◽

Jan Wnent ◽

...

Keyword(s):

Cardiac Arrest ◽

Clinical Outcome ◽

Airway Management ◽

Management Strategies ◽

Hospital Cardiac Arrest

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Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

BioMed Research International ◽

10.1155/2014/376871 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 19

Author(s):

Tomas Henlin ◽

Pavel Michalek ◽

Tomas Tyll ◽

John D. Hinds ◽

Milos Dobias

Keyword(s):

Cardiac Arrest ◽

Tracheal Intubation ◽

Airway Management ◽

Negative Impact ◽

Survival Rates ◽

Early Stages ◽

Published Evidence ◽

Bag Mask Ventilation ◽

Prehospital Airway Management ◽

Hospital Cardiac Arrest

Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

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