Advanced airway management does not improve outcome of out-of-hospital cardiac arrest.
BACKGROUND
The goal of out-of-hospital endotracheal intubation (ETI) is to reduce mortality and morbidity for patients with airway and ventilatory compromise. Yet several studies, mostly involving trauma patients, have demonstrated similar or worse neurologic outcomes and survival-to-hospital discharge rates after out-of-hospital ETI. To date, there is no study comparing out-of-hospital ETI to bag-valve-mask (BVM) ventilation for the outcome of survival to hospital discharge among nontraumatic adult out-of-hospital cardiac arrest (OOHCA) patients.


OBJECTIVE
The objective was to compare survival to hospital discharge among adult OOHCA patients receiving ETI to those managed with BVM.


METHODS
In this retrospective cohort study, the records of all OOHCA patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The type of field airway provided, age, sex, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether the arrest was witnessed, site of arrest, return of spontaneous circulation (ROSC), survival to hospital admission, comorbid illnesses, and survival to hospital discharge were noted. A univariate odds ratio (OR) was first computed to describe the association between the type of airway and survival to hospital discharge. A multivariable logistic regression analysis was performed, adjusting for rhythm, bystander CPR, and whether the arrest was witnessed.


RESULTS
A cohort of 1,294 arrests was evaluated. A total of 1,027 (79.4%) received ETI, while 131 (10.1%) had BVM, 131 (10.1%) had either a Combitube or an esophageal obturator airway, and five (0.4%) had incomplete prehospital records. Fifty-five of 1,294 (4.3%) survived to hospital discharge; there were no survivors in the Combitube/esophageal obturator airway cohort. Even after multivariable adjustment for age, sex, site of arrest, bystander CPR, witnessed arrest, and rhythm on paramedic arrival, the OR for survival to hospital discharge for BVM versus ETI was 4.5 (95% confidence interval [CI] = 2.3-8.9; p<0.0001).


CONCLUSIONS
In this cohort, when compared to BVM ventilation, advanced airway methods were associated with decreased survival to hospital discharge among adult nontraumatic OOHCA patients.
Hanif
M Arslan
MA
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.
Kaji
Amy H
AH
Niemann
James T
JT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000401:mortality* / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000401:mortality*; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome