title: Airway management and out-of-hospital cardiac arrest outcome in the CARES registry.
abstract: BACKGROUND
  Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared OHCA outcomes between patients receiving endotracheal intubation (ETI) versus supraglottic airway (SGA), and between patients receiving [ETI or SGA] and those receiving no advanced airway.
  
  
  METHODS
  We studied adult OHCA in the Cardiac Arrest Registry to Enhance Survival (CARES). Primary exposures were ETI, SGA, or no advanced prehospital airway placed. Primary outcomes were sustained ROSC, survival to hospital admission, survival to hospital discharge, and neurologically-intact survival to hospital discharge (cerebral performance category 1-2). Propensity scores characterized the probability of receiving ETI, SGA, or no advanced airway. We adjusted for Utstein confounders. Multivariable random effects regression accounted for clustering by EMS agency. We compared outcomes between (1) ETI vs. SGA, and (2) [no advanced airway] vs. [ETI or SGA].
  
  
  RESULTS
  Of 10,691 OHCA, 5591 received ETI, 3110 SGA, and 1929 had no advanced airway. Unadjusted neurologically-intact survival was: ETI 5.4%, SGA 5.2%, no advanced airway 18.6%. Compared with SGA, ETI achieved higher sustained ROSC (OR 1.35; 95%CI 1.19-1.54), survival to hospital admission (1.36; 1.19-1.55), hospital survival (1.41; 1.14-1.76) and hospital discharge with good neurologic outcome (1.44; 1.10-1.88). Compared with [ETI or SGA], patients receiving no advanced airway attained higher survival to hospital admission (1.31; 1.16-1.49), hospital survival (2.96; 2.50-3.51) and hospital discharge with good neurologic outcome (4.24; 3.46-5.20).
  
  
  CONCLUSIONS
  In CARES, survival was higher among OHCA receiving ETI than those receiving SGA, and for patients who received no advanced airway than those receiving ETI or SGA.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, United States. Electronic address: Jason.McMullan@uc.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: McMullan
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Gerecht
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, United States.
authors.forename: Jordan
authors.initials: J
authors.lastname: Bonomo
authors.affiliation: Department of Emergency Medicine, Emory University, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Robb
authors.affiliation: Department of Emergency Medicine, Emory University, United States.
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, United States.
authors.forename: John
authors.initials: J
authors.lastname: Donnelly
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, United States.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D004632:Emergency Medical Services; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: Airway management; Endotracheal intubation; Out of hospital cardiac arrest; Supraglottic airway