Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest.
OBJECTIVE
To simplify airway management and minimize cardiopulmonary resuscitation (CPR) chest compression interruptions, some emergency medical services (EMS) practitioners utilize supraglottic airway (SGA) devices instead of endotracheal intubation (ETI) as the primary airway adjunct in out-of-hospital cardiac arrest (OHCA). We compared the outcomes of patients receiving ETI with those receiving SGA following OHCA.


METHODS
We performed a secondary analysis of data from the multicenter Resuscitation Outcomes Consortium (ROC) PRIMED trial. We studied adult non-traumatic OHCA receiving successful SGA insertion (King Laryngeal Tube, Combitube, and Laryngeal Mask Airway) or successful ETI. The primary outcome was survival to hospital discharge with satisfactory functional status (Modified Rankin Scale ≤3). Secondary outcomes included return of spontaneous circulation (ROSC), 24-h survival, major airway or pulmonary complications (pulmonary edema, internal thoracic or abdominal injuries, acute lung injury, sepsis, and pneumonia). Using multivariable logistic regression, we studied the association between out-of-hospital airway management method (ETI vs. SGA) and OHCA outcomes, adjusting for confounders.


RESULTS
Of 10,455 adult OHCA, 8487 (81.2%) received ETI and 1968 (18.8%) received SGA. Survival to hospital discharge with satisfactory functional status was: ETI 4.7%, SGA 3.9%. Compared with successful SGA, successful ETI was associated with increased survival to hospital discharge (adjusted OR 1.40; 95% CI: 1.04, 1.89), ROSC (adjusted OR 1.78; 95% CI: 1.54, 2.04) and 24-h survival (adjusted OR 1.74; 95% CI: 1.49, 2.04). ETI was not associated with secondary airway or pulmonary complications (adjusted OR 0.84; 95% CI: 0.61, 1.16).


CONCLUSIONS
In this secondary analysis of data from the multicenter ROC PRIMED trial, ETI was associated with improved outcomes over SGA insertion after OHCA.
Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA. hwang@uabmc.edu
Henry E
HE
Wang
Daniel
D
Szydlo
John A
JA
Stouffer
Steve
S
Lin
Jestin N
JN
Carlson
Christian
C
Vaillancourt
Gena
G
Sears
Richard P
RP
Verbeek
Raymond
R
Fowler
Ahamed H
AH
Idris
Karl
K
Koenig
James
J
Christenson
Anushirvan
A
Minokadeh
Joseph
J
Brandt
Thomas
T
Rea
D000368:Aged; D005260:Female; D005931:Glottis; D006801:Humans; D007440:Intubation / Q000379:methods*; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome