scholarly journals Association Between Prehospital Airway Management Methods and Neurologic Outcome in Out-Of-Hospital Cardiac Arrest (OHCA) with Respiratory Cause.

2021 ◽  
Author(s):  
Yeongho Choi ◽  
Tae Han Kim ◽  
Ki Jeong Hong ◽  
Kyoung Jun Song ◽  
Sang Do Shin
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Interaction Analysis ◽  
Neurologic Outcome ◽  
Supraglottic Airway ◽  
Neurologic Recovery ◽  
Logistic Regression Models ◽  
Advanced Airway ◽  
Good Neurologic Outcome ◽  
Prehospital Airway Management

Abstract Purpose: Cardiac arrests are resulted by various aetiology including respiratory cause. Advanced airway placement is an important prehospital intervention for oxygenation and ventilation in respiratory cardiac arrest. We evaluated the association between of advanced airway method and neurologic outcome in arrest with respiratory cause.Method: Adult witnessed non-traumatic OHCAs treated by emergency medical service (EMS) providers in 2013-2017 were enrolled in a nationwide OHCA database. The association between airway management methods (endotracheal intubation (ETI), supraglottic airway (SGA) and bag valve mask (BVM)) and outcome were evaluated according to the presumed cause of cardiac arrest (cardiac, respiratory or others). The primary outcome was good neurological recovery at discharge. Multivariable logistic regression models with interaction analysis was conducted.Result: Of 40,443 eligible OHCA patients, the cause of arrest of 90.0%, 7.5%, and 2.4% of patients were categorized as cardiac, respiratory and others, respectively. There were no statistically significant differences in the effect of the advanced airway type on good neurologic recovery in the total population (aOR 0.96 (0.81-1.14) for ETI; 1.01 (95% CI 0.93-1.11) for BVM). However, ETI was associated with better neurologic recovery than SGA or BVM in OHCA in cardiac arrest with suspected respiratory cause (aOR 3.12 (95% CI 1.24-7.80) for ETI; 0.99 (95% CI 0.51-1.91) for BVM).Conclusion: Prehospital ETI was associated with good neurologic outcome when the cause of arrest was respiratory. ETI may be considered initially when a respiratory cause is suspected on the scene.

scholarly journals Association between prehospital airway management methods and neurologic outcome in out-of-hospital cardiac arrest with respiratory cause: a nationwide retrospective observational study

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Interaction Analysis ◽  
Neurologic Outcome ◽  
Supraglottic Airway ◽  
Neurologic Recovery ◽  
Logistic Regression Models ◽  
Advanced Airway ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Cardiac arrests are resulted by various aetiology including respiratory cause. Advanced airway placement is an important prehospital intervention for oxygenation and ventilation in respiratory cardiac arrest. We evaluated the association between of advanced airway method and neurologic outcome in arrest with respiratory cause. Adult witnessed non-traumatic OHCA (out-of-hospital cardiac arrest) treated by emergency medical service (EMS) providers in 2013–2017 were enrolled in a nationwide OHCA database. The association between airway management methods (endotracheal intubation (ETI), supraglottic airway (SGA) and bag valve mask (BVM)) and outcome were evaluated according to the presumed cause of cardiac arrest (cardiac, respiratory or others). The primary outcome was good neurological recovery at discharge. Multivariable logistic regression models with interaction analysis was conducted. Of 40,443 eligible OHCA patients, the cause of arrest of 90.0%, 7.5%, and 2.4% of patients were categorized as cardiac, respiratory and others, respectively. There were no statistically significant differences in the effect of the advanced airway type on good neurologic recovery in the total population (adjusted odds ratio (aOR) 0.96 (0.81–1.14) for ETI; 1.01 (95% confidence intervals (CI) 0.93–1.11) for BVM). However, ETI was associated with better neurologic recovery than SGA or BVM in OHCA in cardiac arrest with suspected respiratory cause (aOR 3.12 (95% CI 1.24–7.80) for ETI; 0.99 (95% CI 0.51–1.91) for BVM). Prehospital ETI was associated with good neurologic outcome when the cause of arrest was respiratory. ETI may be considered initially when a respiratory cause is suspected on the scene.

scholarly journals Prehospital Airway Management: A Systematic Review

2021 ◽  
Author(s):  
Nancy Carney ◽  
Tamara Cheney ◽  
Annette M. Totten ◽  
Rebecca Jungbauer ◽  
Matthew R. Neth ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Neurological Function ◽  
Controlled Trials ◽  
Dynamic Nature ◽  
Randomized Controlled ◽  
Advanced Airway ◽  
First Pass ◽  
Management Approaches ◽  
Prehospital Airway Management

Objective. To assess the comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) by emergency medical services in the prehospital setting, and how the benefits and harms differ based on patient characteristics, techniques, and devices. Data sources. We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020 and reference lists, and posted a Federal Register notice request for data. Review methods. Review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center Program methods guidance. Using pre-established criteria, studies were selected and dual reviewed, data were abstracted, and studies were evaluated for risk of bias. Meta-analyses using profile-likelihood random effects models were conducted when data were available from studies reporting on similar outcomes, with analyses stratified by study design, emergency type, and age. We qualitatively synthesized results when meta-analysis was not indicated. Strength of evidence (SOE) was assessed for primary outcomes (survival, neurological function, return of spontaneous circulation [ROSC], and successful advanced airway insertion [for SGA and ETI only]). Results. We included 99 studies (22 randomized controlled trials and 77 observational studies) involving 630,397 patients. Overall, we found few differences in primary outcomes when airway management approaches were compared. • For survival, there was moderate SOE for findings of no difference for BVM versus ETI in adult and mixed-age cardiac arrest patients. There was low SOE for no difference in these patients for BVM versus SGA and SGA versus ETI. There was low SOE for all three comparisons in pediatric cardiac arrest patients, and low SOE in adult trauma patients when BVM was compared with ETI. • For neurological function, there was moderate SOE for no difference for BVM compared with ETI in adults with cardiac arrest. There was low SOE for no difference in pediatric cardiac arrest for BVM versus ETI and SGA versus ETI. In adults with cardiac arrest, neurological function was better for BVM and ETI compared with SGA (both low SOE). • ROSC was applicable only in cardiac arrest. For adults, there was low SOE that ROSC was more frequent with SGA compared with ETI, and no difference for BVM versus SGA or BVM versus ETI. In pediatric patients there was low SOE of no difference for BVM versus ETI and SGA versus ETI. • For successful advanced airway insertion, low SOE supported better first-pass success with SGA in adult and pediatric cardiac arrest patients and adult patients in studies that mixed emergency types. Low SOE also supported no difference for first-pass success in adult medical patients. For overall success, there was moderate SOE of no difference for adults with cardiac arrest, medical, and mixed emergency types. • While harms were not always measured or reported, moderate SOE supported all available findings. There were no differences in harms for BVM versus SGA or ETI. When SGA was compared with ETI, there were no differences for aspiration, oral/airway trauma, and regurgitation; SGA was better for multiple insertion attempts; and ETI was better for inadequate ventilation. Conclusions. The most common findings, across emergency types and age groups, were of no differences in primary outcomes when prehospital airway management approaches were compared. As most of the included studies were observational, these findings may reflect study design and methodological limitations. Due to the dynamic nature of the prehospital environment, the results are susceptible to indication and survival biases as well as confounding; however, the current evidence does not favor more invasive airway approaches. No conclusion was supported by high SOE for any comparison and patient group. This supports the need for high-quality randomized controlled trials designed to account for the variability and dynamic nature of prehospital airway management to advance and inform clinical practice as well as emergency medical services education and policy, and to improve patient-centered outcomes.

Abstract 163: Type of Prehospital Airway Management Does Not Affect Chest X-Ray Abnormality in Resuscitated Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hiromichi Naito ◽  
Atsunori Nakao ◽  
Alexandra Weissman ◽  
Jonathan Elmer ◽  
Christian Martin-Gill ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Supraglottic Airway ◽  
Positive Pressure ◽  
Thoracic Imaging ◽  
X Ray ◽  
Significant Difference ◽  
Chest X Ray ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Introduction: Chest x-ray (CXR) abnormalities after cardiopulmonary resuscitation are common. Mechanisms by which these abnormalities develop are not fully elucidated, but aspiration of secretions and regurgitated gastric contents during prehospital airway management may be an important modifiable cause. Hypothesis: We hypothesized that endotracheal intubation (ETI) is associated with decreased incidence of CXR abnormalities after out-of-hospital cardiac arrest (OHCA), as compared to bag-valve-mask (BVM) or supraglottic airway (SGA) use. Methods: We conducted a retrospective review including resuscitated OHCA patients treated at a single academic medical center from 2010-2015. We included patients that had an initial CXR obtained within 66 hours of arrival. We excluded patients with tracheostomy, patients without positive pressure ventilation on emergency department (ED) arrival, or missing initial airway management data. We classified patients by airway management at the time of ED arrival into three groups: BVM, SGA, and ETI. Board certified thoracic imaging radiologists determined if there was any CXR abnormality, and if the observed abnormality was likely due to aspiration. The incidence of any abnormality and aspiration were compared between groups. A multivariable logistic regression model was used to adjust for baseline clinical characteristics. Results: Of the 766 subjects included in the study, 22 (3%) had BVM, 68 (9%) had SGA, and 676 (88%) had ETI. Most 58% were male, 34% had initial rhythm VF/VT, and 61% had a witnessed arrest. Any abnormality on CXR was identified in 543 (71%) cases, and likely aspiration was observed in 205 (27%) cases. Incidence of CXR abnormality was not significantly different between groups: BVM group 18/22 (82%), reference; SGA group 52/68 (76%), OR 0.75, 95% CI 0.13-4.31; ETI group 473/676 (70%), OR 0.81, 95% CI 0.16-4.01. Incidence of aspiration on CXR was also not different between groups: BVM group 6/22 (27%), reference; SGA group 19/68 (28%), OR 1.04, 95% CI 0.18-6.22; ETI group 180/676 (27%), OR 1.26, 95% CI 0.25-6.32. Conclusion: Prehospital airway management strategy for resuscitated OHCA patients was not associated with a significant difference in the incidence of any abnormality or aspiration on CXR.

Abstract 118: The Epidemiology of Airway Management Following Pediatric Out-of-Hospital Cardiac Arrest in the United States

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 ◽  
Airway Management ◽  
Multivariable Analysis ◽  
Cerebral Performance Category ◽  
The United States ◽  
Supraglottic Airway ◽  
Shockable Rhythm ◽  
Advanced Airway ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Bag mask ventilation (BMV) has been associated with improved survival following out of hospital cardiac arrest (OHCA), however advanced airway placement remains part of pre-hospital protocols for many emergency medical services (EMS) agencies. Hypothesis: To characterize airway management for pediatric OHCA and assess whether BMV alone vs. BMV plus advanced airway (supraglottic airway or tracheal intubation) is associated with neurologically favorable survival. 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 EMS. To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and shockable rhythm. The primary outcome was favorable neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Results: Of 5241 cardiac arrests, 2588 (49.3%) had BVM and 2653 (50.6%) had advanced airway placement. The majority 5118 (97.7%) were resuscitated by agencies using both BMV and advanced airways. Advanced airway placement was more common in older children compared to infants, arrests with bystander CPR, in white and Hispanic children, witnessed arrests, arrests with a shockable rhythm, and AED use (Table). Neurologically favorable survival was significantly higher with BMV compared to advanced airways in bivariate analysis (11.4% vs. 5.7%, p<0.001). In multivariable analysis, advanced airway placement was associated with lower neurologically favorable survival (adjusted proportion 4.9% vs. 13.5% BVM, OR 0.21, 95% CI 0.17, 0.28). These results were robust on propensity analysis 3.0% advanced airway vs.11.9% BMV (OR 0.18, 95% CI 0.14, 0.25), and entropy balance 5.9% advanced airway, 15.0% for BMV (OR 0.28, 95% CI 0.22). Conclusion: In pediatric OHCA, advanced airways are placed in half of cardiac arrests where resuscitation is attempted. Advanced airway, compared to BMV alone management, is associated with lower neurologically favorable survival.

Abstract 234: The Association Between Post--Cardiac Arrest Hemoglobin Levels and Neurological Outcome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Babette R Rosselot ◽  
Anne V Grossestreuer ◽  
Nora L Lee ◽  
Kalani Dodampahala ◽  
Munish Goyal ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Cerebral Oxygenation ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Secondary Outcome ◽  
Logistic Regression Models ◽  
Patient Demographics ◽  
Neurologic Outcomes ◽  
Good Neurologic Outcome

Background: Inadequate cerebral oxygenation is a risk factor for neurologic damage in successfully resuscitated cardiac arrest patients. One therapy to address this problem is early goal-directed hemodynamic optimization. However, the role of hemoglobin (Hgb) levels, a potential target for optimization, on outcomes in post-cardiac arrest patients is not known. Objective: To determine the association between Hgb levels in post-cardiac arrest patients and neurologic outcome (dichotomized into “good,” a Cerebral Performance Category (CPC) of 1 or 2 and “poor,” a CPC of 3, 4, or 5, at hospital discharge). The association between Hgb levels and survival to discharge was analyzed as a secondary outcome. Methods: A retrospective cohort study was conducted to compare patient demographics and Hgb levels. Hgb was analyzed as both a continuous and binary variable. To determine the association between Hgb levels and outcomes, multivariate logistic regression models controlling for gender, age, pulseless rhythm, and transfusion were used. Results: There were 598 eligible subjects from 21 hospitals in the US. Patients with ≤10 g/dL of Hgb had a higher percentage of subjects with good neurologic outcome than those with Hgb levels below 10 g/dL (41% vs. 26%; p < 0.001). Patients with good neurologic outcome had higher median Hgb levels in the first six hours after arrest than those with a poor neurologic outcome (12.6 g/dL vs. 10.5 g/dL; p < 0.001). Controlling for gender, age, pulseless rhythm, and transfusion, there was a significant relationship between Hgb levels within the first six hours after arrest and good neurologic outcome (OR: 1.21, 95% CI: 1.06 [[Unable to Display Character: &#8211;]] 1.39) and the first 24 hours after arrest and good neurologic outcome (OR: 1.14, 95% CI: 1.01 [[Unable to Display Character: &#8211;]] 1.28). There was a significant association between Hgb levels within the first six hours after arrest and survival to discharge (OR: 1.22, 95% CI: 1.07 [[Unable to Display Character: &#8211;]] 1.39) and Hgb levels within the first 24 hours after arrest and survival to discharge (OR: 1.14, 95% CI: 1.02 [[Unable to Display Character: &#8211;]] 1.28). Conclusions: Higher hemoglobin levels, particularly within the first six hours after cardiac arrest, are associated with better neurologic outcomes at hospital discharge in post-cardiac arrest patients admitted to the hospital.

Abstract 11045: Pre-Hospital Airway for Out-of-Hospital Cardiac Arrest: A Nationwide Multicenter Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Hansol Chang ◽  
Jin Ho Choi ◽  
DAUN JEONG
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Cerebral Performance Category ◽  
Flow Time ◽  
Low Flow ◽  
Supraglottic Airway ◽  
Mask Ventilation ◽  
Advanced Airway ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Introduction: This study investigated whether use of pre-hospital advanced airway management (AAM) is associated with improved survival of adults with out-of hospital cardiac arrest (OHCA) compared to conventional bag-valve-mask ventilation (BVM). Method: The study subjects were derived from Korean Cardiac Arrest Research Consortium (KoCARC), a multi-center OHCA registry of Korea. Patients who underwent AAM or BVM using supraglottic airway, oropharyngeal airway, or endotracheal intubation were compared. The differences in baseline clinical characteristics were adjusted using propensity scoring matching (PSM) or inverse probability of treatment weighting (IPTW). The primary outcome was 30-day survival with neurologically favorable status of cerebral performance category ≤2. The outcome was also compared according to the duration of low-flow time. Results: Of 9,616 patients enrolled, (median age = 71, male sex = 65%) there were 7,583 AAM and 2,033 BVM patients. The unadjusted survival to with neurologically favorable status was lower in AAM compared to BVM (HR = 1.27, 95% confidence interval (CI) = 1.20 - 1.34, p<0.001). However, there was no significant difference of survival to with neurologically favorable status between AAM and BVM after PSM or ITPW-adjusted comparisons (p>0.05, all). This finding was consistent irrespective of duration of low-flow time. Conclusion: In this nationwide real-world data of out-of hospital cardiac arrest study, prehospital advanced airway management compared to bag-and-mask ventilation did not result in an improved clinical outcome at 30 days.

scholarly journals The effect of video-instructed versus audio-instructed dispatcher-assisted cardiopulmonary resuscitation on patient outcomes following out of hospital cardiac arrest in Seoul

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hee Soon Lee ◽  
Kicheol You ◽  
Jin Pyeong Jeon ◽  
Chulho Kim ◽  
Sungeun Kim
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Elderly Patients ◽  
Discharge Rate ◽  
Neurologic Outcome ◽  
Binary Logistic Regression Analysis ◽  
Video Instruction ◽  
Neurologic Recovery ◽  
Metropolitan City ◽  
Hospital Cardiac Arrest

AbstractWe aimed to investigate whether video-instructed dispatcher-assisted (DA)-cardiopulmonary resuscitation (CPR) improved neurologic recovery and survival to discharge compared to audio-instructed DA-CPR in adult out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city with sufficient experience and facilities. A retrospective cohort study was conducted for adult bystander-witnessed OHCA patients administered DA-CPR due to presumed cardiac etiology between January 1, 2018 and October 31, 2019 in Seoul, Korea. The primary and secondary outcomes were the differences in favorable neurologic outcome and survival to discharge rates in adult OHCA patients in the two instruction groups. Binary logistic regression analysis was performed to identify the outcome predictors after DA-CPR. A total of 2109 adult OHCA patients with DA-CPR were enrolled. Numbers of elderly patients in audio instruction and video instruction were 1260 (73.2%) and 214 (55.3%), respectively. Elderly patients and those outside the home or medical facility were more likely to receive video instruction. Favorable neurologic outcome was observed more in patients who received video-instructed DA-CPR (n = 75, 19.4%) than in patients who received audio-instructed DA-CPR (n = 117, 6.8%). The survival to discharge rate was also higher in video-instructed DA-CPR (n = 105, 27.1%) than in audio-instructed DA-CPR (n = 211, 12.3%). Video-instructed DA-CPR was significantly associated with neurologic recovery (aOR = 2.11, 95% CI 1.48–3.01) and survival to discharge (aOR = 1.81, 95% CI 1.33–2.46) compared to audio-instructed DA-CPR in adult OHCA patients after adjusting for age, gender, underlying diseases and CPR location. Video-instructed DA-CPR was associated with favorable outcomes in adult patients with OHCA in a metropolitan city equipped with sufficient experience and facilities.

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