J Yeungnam Med Sci.  2024 Oct;41(4):288-295. 10.12701/jyms.2024.00332.

Outcomes in patients with out-of-hospital cardiac arrest according to prehospital advanced airway management timing: a retrospective observational study

• Lee SH
• Ryoo HW

• KMID: 2560489
• DOI: http://doi.org/10.12701/jyms.2024.00332

Abstract

Background
In patients with out-of-hospital cardiac arrest (OHCA), guidelines recommend advanced airway (AA) management at the advanced cardiovascular life support stage; however, the ideal timing remains controversial. Therefore, we evaluated the prognosis according to the timing of AA in patients with OHCA.
Methods
We conducted a retrospective observational study of patients with OHCA at six major hospitals in Daegu Metropolitan City, South Korea, from August 2019 to June 2022. We compared groups with early and late AA and evaluated prognosis, including recovery of spontaneous circulation (ROSC), survival to discharge, and neurological evaluation, according to AA timing.
Results
Of 2,087 patients with OHCA, 945 underwent early AA management and 1,142 underwent late AA management. The timing of AA management did not influence ROSC in the emergency department (5–6 minutes: adjusted odds ratio [aOR], 0.97; p=0.914; 7–9 minutes: aOR, 1.37; p=0.223; ≥10 minutes: aOR, 1.32; p=0.345). The timing of AA management also did not influence survival to discharge (5–6 minutes: aOR, 0.79; p=0.680; 7–9 minutes: aOR, 1.04; p=0.944; ≥10 minutes: aOR, 1.86; p=0.320) or good neurological outcomes (5–6 minutes: aOR, 1.72; p=0.512; 7–9 minutes: aOR, 0.48; p=0.471; ≥10 minutes: aOR, 0.96; p=0.892).
Conclusion
AA timing in patients with OHCA was not associated with ROSC, survival to hospital discharge, or neurological outcomes.

Keyword

Airway management; Out-of-hospital cardiac arrest; Prognosis

Figure

• 

  Fig. 1. The flow chart of participants. OHCA, out-of-hospital cardiac arrest; ROSC, recovery of spontaneous circulation.

Reference

References

1. Tsao CW, Aday AW, Almarzooq ZI, Anderson CA, Arora P, Avery CL, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023; 147:e93–621.

2. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142(16 Suppl 2):S366–468.

3. Benoit JL, Prince DK, Wang HE. Mechanisms linking advanced airway management and cardiac arrest outcomes. Resuscitation. 2015; 93:124–7.

4. Wang HE, Simeone SJ, Weaver MD, Callaway CW. Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann Emerg Med. 2009; 54:645–52.

5. Studnek JR, Thestrup L, Vandeventer S, Ward SR, Staley K, Garvey L, et al. The association between prehospital endotracheal intubation attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients. Acad Emerg Med. 2010; 17:918–25.

6. Carlson JN, Colella MR, Daya MR, J De Maio V, Nawrocki P, Nikolla DA, et al. Prehospital cardiac arrest airway management: an NAEMSP position statement and resource document. Prehosp Emerg Care. 2022; 26(Suppl 1):54–63.

7. Granfeldt A, Avis SR, Nicholson TC, Holmberg MJ, Moskowitz A, Coker A, et al. Advanced airway management during adult cardiac arrest: a systematic review. Resuscitation. 2019; 139:133–43.

8. Lesnick JA, Moore JX, Zhang Y, Jarvis J, Nichol G, Daya MR, et al. Airway insertion first pass success and patient outcomes in adult out-of-hospital cardiac arrest: The Pragmatic Airway Resuscitation Trial. Resuscitation. 2021; 158:151–6.

9. Murphy DL, Bulger NE, Harrington BM, Skerchak JA, Counts CR, Latimer AJ, et al. Fewer tracheal intubation attempts are associated with improved neurologically intact survival following out-of-hospital cardiac arrest. Resuscitation. 2021; 167:289–96.

10. Izawa J, Iwami T, Gibo K, Okubo M, Kajino K, Kiyohara K, et al. Timing of advanced airway management by emergency medical services personnel following out-of-hospital cardiac arrest: a population-based cohort study. Resuscitation. 2018; 128:16–23.

11. Panchal AR, Berg KM, Kudenchuk PJ, Del Rios M, Hirsch KG, Link MS, et al. 2018 American Heart Association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018; 138:e740–9.

12. Fukuda T, Ohashi-Fukuda N, Inokuchi R, Kondo Y, Sekiguchi H, Taira T, et al. Association between time to advanced airway management and neurologically favourable survival during out-of-hospital cardiac arrest. Anaesth Crit Care Pain Med. 2021; 40:100906.

13. Benoit JL, McMullan JT, Wang HE, Xie C, Xu P, Hart KW, et al. Timing of advanced airway placement after witnessed out-of-hospital cardiac arrest. Prehosp Emerg Care. 2019; 23:838–46.

14. Okubo M, Komukai S, Izawa J, Gibo K, Kiyohara K, Matsuyama T, et al. Timing of prehospital advanced airway management for adult patients with out-of-hospital cardiac arrest: a nationwide cohort study in Japan. J Am Heart Assoc. 2021; 10:e021679.

15. Okubo M, Komukai S, Izawa J, Aufderheide TP, Benoit JL, Carlson JN, et al. Association of advanced airway insertion timing and outcomes after out-of-hospital cardiac arrest. Ann Emerg Med. 2022; 79:118–31.

16. Kim J, Kim K, Kim T, Rhee JE, Jo YH, Lee JH, et al. The clinical significance of a failed initial intubation attempt during emergency department resuscitation of out-of-hospital cardiac arrest patients. Resuscitation. 2014; 85:623–7.

17. Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018; 120:323–52.

18. Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013; 20:71–8.

19. Ljungqvist H, Pirneskoski J, Saviluoto A, Setälä P, Tommila M, Nurmi J. Intubation first-pass success in a high performing pre-hospital critical care system is not associated with 30-day mortality: a registry study of 4496 intubation attempts. Scand J Trauma Resusc Emerg Med. 2022; 30:61.