Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest

for the ROC investigators

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Select Emergency Medical Services (EMS) practitioners substitute endotracheal intubation (ETI) with supraglottic airway (SGA) insertion to minimize CPR chest compression interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult out-of-hospital cardiac arrest (OHCA) receiving ETI and those receiving SGA. Methods: We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation using an Impedance valve and an Early vs. Delayed analysis (PRIMED) trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA (Combitube, King Laryngeal Tube, or Laryngeal Mask Airway) and >2. min of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique. Results: Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2767 cases, including 2051 ETI, 671 SGA, and 45 both. Among subjects in this investigation the mean age was 66.4 years with a male predominace, 46% with witnessed event, 37% receiving bystander CPR, and 22% presenting with an initially shockable rhythm. Pre- and post-airway CCF was higher for SGA than ETI (SGA pre-airway CCF 73.2% [95%CI: 71.6-74.7%] vs. ETI 70.6% [95%CI: 69.7-71.5%]; post-airway 76.7% [95%CI: 75.2-78.1%] vs. 72.4% [95%CI: 71.5-73.3%]). After adjusting for potential confounders, these significant changes persisted (pre-airway difference 2.2% favoring SGA, p-value. =. 0.046; post-airway 3.4% favoring SGA, p=. 0.001). Conclusion: In patients with OHCA, we detected a slightly higher rate of CCF in patients for whom a SGA was inserted, both before and after insertion. However, the actual differences were so small, that in the context of this observational, secondary analysis, it is unclear if this represents a clinically significant difference.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalResuscitation
Volume98
DOIs
StatePublished - Jan 1 2016

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Heart Arrest
Thorax
Intratracheal Intubation
Equipment and Supplies
Out-of-Hospital Cardiac Arrest
Resuscitation
Cardiopulmonary Resuscitation
Electric Impedance
Data Compression
Laryngeal Masks
Emergency Medical Services
Arm

Keywords

  • Cardiac arrest
  • CPR
  • Emergency Medical Services
  • Endotracheal intubation
  • Supraglottic airway

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest. / for the ROC investigators.

In: Resuscitation, Vol. 98, 01.01.2016, p. 35-40.

Research output: Contribution to journalArticle

@article{6649e5ab287d4519b80dd92079ac8101,
title = "Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest",
abstract = "Background: Select Emergency Medical Services (EMS) practitioners substitute endotracheal intubation (ETI) with supraglottic airway (SGA) insertion to minimize CPR chest compression interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult out-of-hospital cardiac arrest (OHCA) receiving ETI and those receiving SGA. Methods: We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation using an Impedance valve and an Early vs. Delayed analysis (PRIMED) trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA (Combitube, King Laryngeal Tube, or Laryngeal Mask Airway) and >2. min of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique. Results: Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2767 cases, including 2051 ETI, 671 SGA, and 45 both. Among subjects in this investigation the mean age was 66.4 years with a male predominace, 46{\%} with witnessed event, 37{\%} receiving bystander CPR, and 22{\%} presenting with an initially shockable rhythm. Pre- and post-airway CCF was higher for SGA than ETI (SGA pre-airway CCF 73.2{\%} [95{\%}CI: 71.6-74.7{\%}] vs. ETI 70.6{\%} [95{\%}CI: 69.7-71.5{\%}]; post-airway 76.7{\%} [95{\%}CI: 75.2-78.1{\%}] vs. 72.4{\%} [95{\%}CI: 71.5-73.3{\%}]). After adjusting for potential confounders, these significant changes persisted (pre-airway difference 2.2{\%} favoring SGA, p-value. =. 0.046; post-airway 3.4{\%} favoring SGA, p=. 0.001). Conclusion: In patients with OHCA, we detected a slightly higher rate of CCF in patients for whom a SGA was inserted, both before and after insertion. However, the actual differences were so small, that in the context of this observational, secondary analysis, it is unclear if this represents a clinically significant difference.",
keywords = "Cardiac arrest, CPR, Emergency Medical Services, Endotracheal intubation, Supraglottic airway",
author = "{for the ROC investigators} and Kurz, {Michael Christopher} and Prince, {David K.} and James Christenson and Jestin Carlson and Dion Stub and Sheldon Cheskes and Steve Lin and Michael Aziz and Michael Austin and Christian Vaillancourt and Justin Colvin and Wang, {Henry E.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1016/j.resuscitation.2015.10.011",
language = "English (US)",
volume = "98",
pages = "35--40",
journal = "Resuscitation",
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T1 - Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest

AU - for the ROC investigators

AU - Kurz, Michael Christopher

AU - Prince, David K.

AU - Christenson, James

AU - Carlson, Jestin

AU - Stub, Dion

AU - Cheskes, Sheldon

AU - Lin, Steve

AU - Aziz, Michael

AU - Austin, Michael

AU - Vaillancourt, Christian

AU - Colvin, Justin

AU - Wang, Henry E.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Select Emergency Medical Services (EMS) practitioners substitute endotracheal intubation (ETI) with supraglottic airway (SGA) insertion to minimize CPR chest compression interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult out-of-hospital cardiac arrest (OHCA) receiving ETI and those receiving SGA. Methods: We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation using an Impedance valve and an Early vs. Delayed analysis (PRIMED) trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA (Combitube, King Laryngeal Tube, or Laryngeal Mask Airway) and >2. min of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique. Results: Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2767 cases, including 2051 ETI, 671 SGA, and 45 both. Among subjects in this investigation the mean age was 66.4 years with a male predominace, 46% with witnessed event, 37% receiving bystander CPR, and 22% presenting with an initially shockable rhythm. Pre- and post-airway CCF was higher for SGA than ETI (SGA pre-airway CCF 73.2% [95%CI: 71.6-74.7%] vs. ETI 70.6% [95%CI: 69.7-71.5%]; post-airway 76.7% [95%CI: 75.2-78.1%] vs. 72.4% [95%CI: 71.5-73.3%]). After adjusting for potential confounders, these significant changes persisted (pre-airway difference 2.2% favoring SGA, p-value. =. 0.046; post-airway 3.4% favoring SGA, p=. 0.001). Conclusion: In patients with OHCA, we detected a slightly higher rate of CCF in patients for whom a SGA was inserted, both before and after insertion. However, the actual differences were so small, that in the context of this observational, secondary analysis, it is unclear if this represents a clinically significant difference.

AB - Background: Select Emergency Medical Services (EMS) practitioners substitute endotracheal intubation (ETI) with supraglottic airway (SGA) insertion to minimize CPR chest compression interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult out-of-hospital cardiac arrest (OHCA) receiving ETI and those receiving SGA. Methods: We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation using an Impedance valve and an Early vs. Delayed analysis (PRIMED) trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA (Combitube, King Laryngeal Tube, or Laryngeal Mask Airway) and >2. min of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique. Results: Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2767 cases, including 2051 ETI, 671 SGA, and 45 both. Among subjects in this investigation the mean age was 66.4 years with a male predominace, 46% with witnessed event, 37% receiving bystander CPR, and 22% presenting with an initially shockable rhythm. Pre- and post-airway CCF was higher for SGA than ETI (SGA pre-airway CCF 73.2% [95%CI: 71.6-74.7%] vs. ETI 70.6% [95%CI: 69.7-71.5%]; post-airway 76.7% [95%CI: 75.2-78.1%] vs. 72.4% [95%CI: 71.5-73.3%]). After adjusting for potential confounders, these significant changes persisted (pre-airway difference 2.2% favoring SGA, p-value. =. 0.046; post-airway 3.4% favoring SGA, p=. 0.001). Conclusion: In patients with OHCA, we detected a slightly higher rate of CCF in patients for whom a SGA was inserted, both before and after insertion. However, the actual differences were so small, that in the context of this observational, secondary analysis, it is unclear if this represents a clinically significant difference.

KW - Cardiac arrest

KW - CPR

KW - Emergency Medical Services

KW - Endotracheal intubation

KW - Supraglottic airway

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