Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts

Jarman, Angela F.; Hopkins, Christy L.; Hansen, Jan; Brown, Jonathan R.; Burk, Christopher; Youngquist, Scott T.

doi:10.1080/10903127.2017.1308611

Cited by 35 publications

(23 citation statements)

References 41 publications

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“…However, repeated attempts after failed initial DL (but not VL) during CPR were associated with an increase in the number of pauses in chest compression delivery. 56 Ongoing clinical trials may provide more insight into the optimal airway management during cardiac arrests in the out-of-hospital setting (clinicaltrials.gov identifiers NCT02419573 and NCT02327026, and isrctn.com identifier ISRCTN08256118).…”

Section: Discussionmentioning

confidence: 99%

Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis

Arulkumaran

Lowe

Ions

et al. 2018

British Journal of Anaesthesia

134

103

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Videolaryngoscopy (VL) may improve the success of orotracheal intubation compared with direct laryngoscopy (DL). We performed a systematic search of PubMed, Embase, and CENTRAL databases for studies comparing VL and DL for emergency orotracheal intubations outside the operating room. The primary outcome was rate of first-pass intubation, with subgroup analyses by location, device used, clinician experience, and clinical scenario. The secondary outcome was complication rates. Data are presented as [odds ratio (95% confidence intervals); P-values]. We identified 32 studies with 15 064 emergency intubations. There was no difference in first-pass intubation with VL compared with DL [OR=1.28, (0.99-1.65); P=0.06]. First-pass intubations were increased with VL compared with DL in the intensive care unit (ICU) [2.02 (1.43-2.85); P<0.001], and similar in the emergency department or pre-hospital setting. First-pass intubations were similar with GlideScope, but improved with the CMAC [1.32 (1.08-1.62); P=0.007] compared with DL. There was greater first-pass intubation with VL compared with DL amongst novice/trainee clinicians [OR=1.95 (1.45-2.64); P<0.001], but not amongst experienced clinicians or paramedics/nurses. There was no difference in first-pass intubation with VL compared with DL during cardiopulmonary resuscitation or trauma. VL compared with DL was associated with fewer oesophageal intubations [OR=0.32 (0.14-0.70); P=0.003], but more arterial hypotension [OR=1.49 (1.00-2.23); P=0.05]. In summary, VL compared with DL is associated with greater first-pass emergency intubation in the ICU and amongst less experienced clinicians, and reduces oesophageal intubations. However, VL is associated with greater incidence of arterial hypotension. Further trials investigating the utility of VL over DL in specific situations are required.

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Section: Discussionmentioning

confidence: 99%

Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis

Arulkumaran

Lowe

Ions

et al. 2018

British Journal of Anaesthesia

134

103

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“…A previous study by Wang et al found that ETI performance was associated with chest compression interruptions, and that the no-flow time was actually extended in situations where CPR was required. 19 Jarman et al 20 reported no differences in CPR interruption time according to the prehospital airway management method, and showed that the failure of the first ETI attempt via direct laryngoscopy actually increased the duration of interrupted chest compressions. Therefore, we must consider the possibility that interrupted chest compressions do not differ according to the airway management method and may actually increase for subjects who undergo advanced airway management; this would explain why advanced management did not affect the neurologic outcomes in real-world situations.…”

Section: Discussionmentioning

confidence: 99%

Comparing the neurologic outcomes of patients with out-of-hospital cardiac arrest according to prehospital advanced airway management method and transport time interval

et al. 2020

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Objective The incidences of prehospital advanced airway management by emergency medical technicians in South Korea are increasing; however, whether this procedure improves the survival outcomes of patients experiencing out-of-hospital cardiac arrest remains unclear. The present study aimed to investigate the association between prehospital advanced airway management and neurologic outcomes according to a transport time interval (TTI) using the Korean Cardiac Arrest Research Consortium database. Methods We retrospectively analyzed the favorable database entries that were prospectively collected between October 2015 and December 2016. Patients aged 18 years or older who experienced cardiac arrest that was presumed to be of a medical etiology and that occurred prior to the arrival of emergency medical service personnel were included. The exposure variable was the type of prehospital airway management provided by emergency medical technicians. The primary endpoint was a favorable neurologic outcome. Results Of 1,871 patients who experienced out-of-hospital cardiac arrest, 785 (42.0%), 121 (6.5%), and 965 (51.6%) were managed with bag-valve-mask ventilation, endotracheal intubation (ETI), and supraglottic airway (SGA) devices, respectively. SGAs and ETI provided no advantage in terms of favorable neurologic outcome in patients with TTIs ≥ 12 minutes (odds ratio [OR], 1.37; confidence interval [CI], 0.65-2.87 for SGAs; OR, 1.31; CI, 0.30-5.81 for ETI) or in patients with TTI < 12 minutes (OR, 0.57; CI, 0.31-1.07 for SGAs; OR, 0.63; CI, 0.12-3.26 for ETI). Conclusion Neither the prehospital use of SGA nor administration of ETI was associated with superior neurologic outcomes compared with bag-valve-mask ventilation.

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“…In one study of experienced clinicians, VL was associated with significantly fewer episodes of prolonged (> 10 s) interruptions in chest compressions; the intubation success rate was not significantly different [ 26 ]. In a further study, VL use was associated with shorter pauses in compressions compared with direct laryngoscopy when initial tracheal intubation was not successful [ 27 ].…”

Section: Airway and Ventilation Techniques During Cprmentioning

confidence: 99%

“…In an observational study of 100 pre-hospital intubations by paramedics, tracheal intubation attempts during CPR caused a median 110 s (IQR 54–198 s) of interruption, and in a quarter of cases the interruptions were over 3 minutes [ 19 ]. More recent OHCA observational data (339 patients) suggest duration of the longest pauses, number of pauses over 10 s and chest compression fraction (proportion of time compressions being given) may be similar with bag-mask, SGA and tracheal intubation [ 27 ]. In addition, data from 2767 cases of OHCA suggest the chest compression fraction is only slightly less with a tracheal tube (72.4 vs 76.7%) [ 34 ].…”

Section: Comparisons Between Airway Techniques During Cprmentioning

confidence: 99%

Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation

2018

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After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of spontaneous circulation (ROSC). The optimal combination of airway techniques, oxygenation and ventilation is uncertain. Current guidelines are based predominantly on evidence from observational studies and expert consensus; recent and ongoing randomised controlled trials should provide further information. This narrative review describes the current evidence, including the relative roles of basic and advanced (supraglottic airways and tracheal intubation) airways, oxygenation and ventilation targets during CPR and after ROSC in adults. Current evidence supports a stepwise approach to airway management based on patient factors, rescuer skills and the stage of resuscitation. During CPR, rescuers should provide the maximum feasible inspired oxygen and use waveform capnography once an advanced airway is in place. After ROSC, rescuers should titrate inspired oxygen and ventilation to achieve normal oxygen and carbon dioxide targets.

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Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts

Cited by 35 publications

References 41 publications

Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis

Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis

Comparing the neurologic outcomes of patients with out-of-hospital cardiac arrest according to prehospital advanced airway management method and transport time interval

Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation

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