TY - JOUR
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.
N1 - Funding Information:
The ROC is supported by a series of cooperative agreements to nine regional clinical centers and one Data Coordinating Center ( 5U01 HL077863 University of Washington Data Coordinating Center , HL077866 Medical College of Wisconsin , HL077867 University of Washington , HL077871 University of Pittsburgh , HL077872 St. Michael's Hospital , HL077873 Oregon Health and Science University , HL077881 University of Alabama at Birmingham , HL077885 Ottawa Health Research Institute , HL077887 University of Texas SW Medical Center/Dallas , HL077908 University of California San Diego) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke , US Army Medical Research & Material Command, The Canadian Institutes of Health Research (CIHR)–Institute of Circulatory and Respiratory Health, Defense Research and Development Canada and the Heart, Stroke Foundation of Canada and the American Heart Association . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute or the National Institutes of Health .
Publisher Copyright:
© 2015 Elsevier Ireland Ltd.
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 - CPR
KW - Cardiac arrest
KW - Emergency Medical Services
KW - Endotracheal intubation
KW - Supraglottic airway
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U2 - 10.1016/j.resuscitation.2015.10.011
DO - 10.1016/j.resuscitation.2015.10.011
M3 - Article
C2 - 26520783
AN - SCOPUS:84953923568
VL - 98
SP - 35
EP - 40
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
ER -