title: Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study.
abstract: BACKGROUND
  The effect of prehospital use of supraglottic airway devices as an alternative to tracheal intubation on long-term outcomes of patients with out-of-hospital cardiac arrest is unclear.
  
  
  OBJECTIVE
  We compared the neurological outcomes of patients who underwent supraglottic airway device insertion with those who underwent tracheal intubation.
  
  
  METHODS
  We conducted a nationwide population-based observational study using a national database containing all out-of-hospital cardiac arrest cases in Japan over a 3-year period (2005-2007). The rates of neurologically favorable 1-month survival (primary outcome) and of 1-month survival and return of spontaneous circulation before hospital arrival (secondary outcomes) were examined. Multiple logistic regression analyses were performed to adjust for potential confounders. Advanced airway devices were used in 138,248 of 318,141 patients, including an endotracheal tube (ETT) in 16,054 patients (12%), a laryngeal mask airway (LMA) in 34,125 patients (25%), and an esophageal obturator airway (EOA) in 88,069 patients (63%).
  
  
  RESULTS
  The overall rate of neurologically favorable 1-month survival was 1.03% (1426/137,880). The rates of neurologically favorable 1-month survival were 1.14% (183/16,028) in the ETT group, 0.98% (333/34,059) in the LMA group, and 1.04% (910/87,793) in the EOA group. Compared with the ETT group, the rates were significantly lower in the LMA group (adjusted odds ratio 0.77, 95% confidence interval [CI] 0.64-0.94) and EOA group (adjusted odds ratio 0.81, 95% CI 0.68-0.96).
  
  
  CONCLUSIONS
  Prehospital use of supraglottic airway devices was associated with slightly, but significantly, poorer neurological outcomes compared with tracheal intubation, but neurological outcomes remained poor overall.
authors.affiliation: Foundation for Ambulance Service Development, Emergency Life-Saving Technique Academy of Tokyo, Tokyo, Japan.
authors.forename: Seizan
authors.initials: S
authors.lastname: Tanabe
authors.forename: Toshio
authors.initials: T
authors.lastname: Ogawa
authors.forename: Manabu
authors.initials: M
authors.lastname: Akahane
authors.forename: Soichi
authors.initials: S
authors.lastname: Koike
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Mizoguchi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hatanaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Imamura
mesh_terms: D000368:Aged; D058109:Airway Management / Q000295:instrumentation*; D000704:Analysis of Variance; D016208:Databases, Factual; D004632:Emergency Medical Services; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007442:Intubation, Intratracheal; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D015996:Survival Rate