title: Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  It is unclear whether advanced airway management such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting improves outcomes following out-of-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask ventilation.
  
  
  OBJECTIVE
  To test the hypothesis that prehospital advanced airway management is associated with favorable outcome after adult OHCA.
  
  
  METHODS
  Prospective, nationwide, population-based study (All-Japan Utstein Registry) involving 649,654 consecutive adult patients in Japan who had an OHCA and in whom resuscitation was attempted by emergency responders with subsequent transport to medical institutions from January 2005 through December 2010.
  
  
  METHODS
  Favorable neurological outcome 1 month after an OHCA, defined as cerebral performance category 1 or 2.
  
  
  RESULTS
  Of the eligible 649,359 patients with OHCA, 367,837 (57%) underwent bag-valve-mask ventilation and 281,522 (43%) advanced airway management, including 41,972 (6%) with endotracheal intubation and 239,550 (37%) with use of supraglottic airways. In the full cohort, the advanced airway group incurred a lower rate of favorable neurological outcome compared with the bag-valve-mask group (1.1% vs 2.9%; odds ratio [OR], 0.38; 95% CI, 0.36-0.39). In multivariable logistic regression, advanced airway management had an OR for favorable neurological outcome of 0.38 (95% CI, 0.37-0.40) after adjusting for age, sex, etiology of arrest, first documented rhythm, witnessed status, type of bystander cardiopulmonary resuscitation, use of public access automated external defibrillator, epinephrine administration, and time intervals. Similarly, the odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41; 95% CI, 0.37-0.45) and for supraglottic airways (adjusted OR, 0.38; 95% CI, 0.36-0.40). In a propensity score-matched cohort (357,228 patients), the adjusted odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.45; 95% CI, 0.37-0.55) and for use of supraglottic airways (adjusted OR, 0.36; 95% CI, 0.33-0.39). Both endotracheal intubation and use of supraglottic airways were similarly associated with decreased odds of neurologically favorable survival.
  
  
  CONCLUSIONS
  Among adult patients with OHCA, any type of advanced airway management was independently associated with decreased odds of neurologically favorable survival compared with conventional bag-valve-mask ventilation.
authors: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 326 Cambridge St, Ste 410, Boston, MA 02114, USA. khasegawa1@partners.org
authors: Kohei
authors: K
authors: Hasegawa
authors: Atsushi
authors: A
authors: Hiraide
authors: Yuchiao
authors: Y
authors: Chang
authors: David F M
authors: DF
authors: Brown
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D016887:Cardiopulmonary Resuscitation; D003072:Cognition Disorders / Q000209:etiology; D004632:Emergency Medical Services; D004635:Emergency Medicine; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome