title: Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest.
abstract: BACKGROUND
  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.
authors: Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31 Kitayama-cho Tennouji-ku, Osaka 543-0035, Japan. kajihanapu@yahoo.co.jp
authors: Kentaro
authors: K
authors: Kajino
authors: Taku
authors: T
authors: Iwami
authors: Tetsuhisa
authors: T
authors: Kitamura
authors: Mohamud
authors: M
authors: Daya
authors: Marcus Eng Hock
authors: ME
authors: Ong
authors: Tatsuya
authors: T
authors: Nishiuchi
authors: Yasuyuki
authors: Y
authors: Hayashi
authors: Tomohiko
authors: T
authors: Sakai
authors: Takeshi
authors: T
authors: Shimazu
authors: Atsushi
authors: A
authors: Hiraide
authors: Masashi
authors: M
authors: Kishi
authors: Shigeru
authors: S
authors: Yamayoshi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007564:Japan; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome