title: Use of rapid sequence intubation predicts improved survival among patients intubated after out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  Some observational studies indicate that endotracheal intubation is associated with a worse outcome compared to bag-mask ventilation after out-of-hospital cardiac arrest in emergency medical services (EMS) systems without rapid sequence intubation (RSI). We evaluated the role of RSI in airway management following cardiac arrest.
  
  
  METHODS
  We conducted a cohort study of all non-traumatic arrest patients treated by a metropolitan EMS system from 2007 to 2011. Advanced airway management information was obtained from a prospective airway registry and linked to a cardiac arrest registry. We used multivariate logistic regression to estimate the association between attempted intubation status and survival to hospital discharge.
  
  
  RESULTS
  Of 3133 patients, 82% underwent attempted intubation without RSI, 15% underwent attempted RSI, and 3% experienced no intubation attempt. Survival to hospital discharge differed by attempted intubation status: 11% (n=291/2576) for intubation without RSI, 48% (n=226/471) for RSI, and 71% (n=61/86) for "no intubation." Compared to the intubation without RSI group, the adjusted odds ratios of survival were 5.6 (95% CI 4.3, 7.2) for the RSI group and 15 (95% CI 9, 27) for the "no intubation" group.
  
  
  CONCLUSIONS
  In this population-based cohort of out-of-hospital cardiac arrest, RSI was used in 15% of patients and associated with a better prognosis than intubation attempted without paralytics. Because this subset with a favorable prognosis may not be readily intubated in systems without paralytics, these findings could help to explain the adverse relationship between intubation and survival observed in prior studies.
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States; Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, United States. Electronic address: heemun@uw.edu.
authors.forename: Heemun
authors.initials: H
authors.lastname: Kwok
authors.forename: Matthew
authors.initials: M
authors.lastname: Prekker
authors.forename: Andreas
authors.initials: A
authors.lastname: Grabinsky
authors.forename: David
authors.initials: D
authors.lastname: Carlbom
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: Airway management; Cardiopulmonary resuscitation; Heart arrest