Clin Exp Emerg Med.  2020 Jun;7(2):95-106. 10.15441/ceem.19.022.

Variability in the effects of prehospital advanced airway management on outcomes of patients with out-of-hospital cardiac arrest

  • 1Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
  • 2Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 3Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
  • 4Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
  • 5Department of Emergency and General Medicine, Amagasaki General Medical Center, Osaka, Japan
  • 6Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
  • 7Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
  • 8Department of Emergency Medicine, Singapore General Hospital, Singapore
  • 9Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
  • 10Emergency Department, Tan Tock Seng Hospital, Singapore
  • 11Home Team Medical Services Division, Ministry of Home Affairs, Singapore
  • 12Emergency Medicine Department, National University Hospital, Singapore


To investigate variations in the effects of prehospital advanced airway management (AAM) on outcomes of out-of-hospital cardiac arrest (OHCA) patients according to regional emergency medical service (EMS) systems in four Asian cities.
We enrolled adult patients with EMS-treated OHCA of presumed cardiac origin between 2012 and 2014 from Osaka (Japan), Seoul (Republic of Korea), Singapore (Singapore), and Taipei (Taiwan). The main exposure variable was prehospital AAM. The primary endpoint was neurological recovery. We compared outcomes between the prehospital AAM and non-AAM groups using multivariable logistic regression with an interaction term between prehospital AAM and the four Asian cities.
A total of 16,510 patients were included in the final analyses. The rates of prehospital AAM varied among Osaka, Seoul, Singapore, and Taipei (65.0%, 19.2%, 84.9%, and 34.1%, respectively). The non-AAM group showed better outcomes than the AAM group (adjusted odds ratio [aOR] for neurological recovery 0.30; 95% confidence interval [CI], 0.24–0.38]). In the interaction model for neurological recovery, the aORs for AAM in Osaka and Singapore were 0.12 (95% CI, 0.06–0.26) and 0.21 (95% CI, 0.16–0.28), respectively. In Seoul and Taipei, the association between prehospital AAM and neurological recovery was not significant (aOR 0.58 [95% CI, 0.31–1.10] and 0.79 [95% CI, 0.52–1.20], respectively). The interaction between prehospital AAM and region was significant (P=0.01).
The effects of prehospital AAM on outcomes of OHCA patients differed according to regional variability in the EMS systems.


Out-of-hospital cardiac arrest; Airway management; Emergency medical services
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