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

Abstract

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.

Prehospital airway management for out‐of‐hospital cardiac arrest: A nationwide multicenter study from the KoCARC registry

“…In Korean observational studies, AAM was better than BVM in the analysis of an OHCA surveillance database from 2010 to 2013 2 but was not better than BVM in the analysis of a database from 2015 to 2016 30 . Meanwhile, the implementation rate of supraglottic airway increased consistently, from 5.0% in the study from 2010 to 2013, 51.6% in the study from 2015 to 2016, and 56.4% in our study.…”

“…to 2016 30. Meanwhile, the implementation rate of supraglottic airway increased consistently, from 5.0% in the study from 2010 to 2013, 51.6% in the study from 2015 to 2016, and 56.4% in our study.…”

Effect of citywide enhancement of the chain of survival on good neurologic outcomes after out-of-hospital cardiac arrest from 2008 to 2017

“…As a result of previous EMS interventions, the rates of dual-dispatch responses and advanced airway management gradually increased. The effect of the dual-dispatch system and advanced airway management on the improvement in outcomes after OHCA is unclear [ 7 , 15 – 17 ]. However, we expected positive effects by increasing the rapid success rate of prehospital advanced airway management and well-coordinated team approach in prehospital EMS.…”