Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Kentaro Kajino, Taku Iwami, Tetsuhisa Kitamura, Mohamud Ramzan Daya, Marcus E H Ong, Tatsuya Nishiuchi, Yasuyuki Hayashi, Tomohiko Sakai, Takeshi Shimazu, Atsushi Hiraide, Masashi Kishi, Shigeru Yamayoshi

Research output: Contribution to journalArticle

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Abstract

Introduction: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.Methods: All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.Results: Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P <0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.Conclusions: There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.

Original languageEnglish (US)
Article numberR236
JournalCritical Care
Volume15
Issue number5
DOIs
StatePublished - Oct 10 2011

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Out-of-Hospital Cardiac Arrest
Intratracheal Intubation
Equipment and Supplies
Airway Management
Odds Ratio
Confidence Intervals
Therapeutics
Japan
Emergencies
Emergency Medical Services
Heart Arrest
Multivariate Analysis
Logistic Models
Outcome Assessment (Health Care)
Databases

Keywords

  • Advanced airway
  • Cardiac arrest
  • Endotracheal intubation
  • Pre-hospital
  • Resuscitation
  • Supraglottic airway

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. / Kajino, Kentaro; Iwami, Taku; Kitamura, Tetsuhisa; Daya, Mohamud Ramzan; Ong, Marcus E H; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Sakai, Tomohiko; Shimazu, Takeshi; Hiraide, Atsushi; Kishi, Masashi; Yamayoshi, Shigeru.

In: Critical Care, Vol. 15, No. 5, R236, 10.10.2011.

Research output: Contribution to journalArticle

Kajino, K, Iwami, T, Kitamura, T, Daya, MR, Ong, MEH, Nishiuchi, T, Hayashi, Y, Sakai, T, Shimazu, T, Hiraide, A, Kishi, M & Yamayoshi, S 2011, 'Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest', Critical Care, vol. 15, no. 5, R236. https://doi.org/10.1186/cc10483
Kajino, Kentaro ; Iwami, Taku ; Kitamura, Tetsuhisa ; Daya, Mohamud Ramzan ; Ong, Marcus E H ; Nishiuchi, Tatsuya ; Hayashi, Yasuyuki ; Sakai, Tomohiko ; Shimazu, Takeshi ; Hiraide, Atsushi ; Kishi, Masashi ; Yamayoshi, Shigeru. / Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. In: Critical Care. 2011 ; Vol. 15, No. 5.
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abstract = "Introduction: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.Methods: All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.Results: Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6{\%} versus 3.6{\%}, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P <0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95{\%} confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95{\%} CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95{\%} CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.Conclusions: There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.",
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AU - Kajino, Kentaro

AU - Iwami, Taku

AU - Kitamura, Tetsuhisa

AU - Daya, Mohamud Ramzan

AU - Ong, Marcus E H

AU - Nishiuchi, Tatsuya

AU - Hayashi, Yasuyuki

AU - Sakai, Tomohiko

AU - Shimazu, Takeshi

AU - Hiraide, Atsushi

AU - Kishi, Masashi

AU - Yamayoshi, Shigeru

PY - 2011/10/10

Y1 - 2011/10/10

N2 - Introduction: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.Methods: All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.Results: Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P <0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.Conclusions: There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.

AB - Introduction: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.Methods: All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.Results: Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P <0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.Conclusions: There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.

KW - Advanced airway

KW - Cardiac arrest

KW - Endotracheal intubation

KW - Pre-hospital

KW - Resuscitation

KW - Supraglottic airway

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