Document Detail

Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.
MedLine Citation:
PMID:  23321764     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: 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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
MAIN OUTCOME MEASURES: 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.
CONCLUSION AND RELEVANCE: 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.
Kohei Hasegawa; Atsushi Hiraide; Yuchiao Chang; David F M Brown
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-16     Completed Date:  2013-01-18     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-66     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Airway Management / methods*
Cardiopulmonary Resuscitation
Cognition Disorders / etiology
Emergency Medical Services
Emergency Medicine
Glasgow Outcome Scale*
Intubation, Intratracheal / methods
Logistic Models
Middle Aged
Nervous System Diseases / etiology
Odds Ratio
Out-of-Hospital Cardiac Arrest / complications*,  mortality*,  therapy
Prospective Studies
Treatment Outcome
Comment In:
JAMA. 2013 May 8;309(18):1888   [PMID:  23652513 ]
JAMA. 2013 May 8;309(18):1889-90   [PMID:  23652515 ]
JAMA. 2013 Jan 16;309(3):285-6   [PMID:  23321768 ]
JAMA. 2013 May 8;309(18):1888-9   [PMID:  23652514 ]

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