Effect of Placement of a Supraglottic Airway Device vs Endotracheal Intubation on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest in Taipei, Taiwan

Lee, An-Fu; Chien, Yu-Chun; Lee, Bin-Chou; Yang, Wen-Shuo; Wang, Yaocheng; Lin, Hao-Yang; Huang, Edward Pei-Chuan; Chong, Kah-Meng; Sun, Jen‐Tang; Huei‐Ming, Matthew; Hsieh, Ming‐Ju; Chiang, Wen-Chu

doi:10.1001/jamanetworkopen.2021.48871

Cited by 22 publications

(23 citation statements)

References 21 publications

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“…Hence, alternative methods for advanced airway management may find a place in patient management. However, a recent trial found that supraglottic placement of a supraglottic airway device was not superior to endotracheal intubation after cardiac arrest [ 30 ]. Fluid administration is usually required concurrently, as the introduction of positive intrathoracic pressure can induce a severe hypotension in hypovolaemic patients.…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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“…Indeed, when an advanced airway is used, SGA is suggested in settings with a low ETI success rate, leaving the use of endotracheal tubes to professional rescuers with high ETI success rates, i.e., >95% within two attempts [ 14 ]. The “Supraglottic Airway Device vs. Endotracheal Intubation” (SAVE) trial [ 17 ] compared the effectiveness of ETI vs. SGA in adult patients with non-traumatic OHCA, targeting sustained ROSC as the primary outcome. EMS systems were cluster-randomized to ETI or SGA, and a total of 936 patients (517 in the ETI group and 419 in the SGA group) were included in the primary analysis.…”

Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

“…Sustained ROSC was achieved in 26.9% of patients after ETI vs. 25.8% after SGA. No differences in survival to hospital discharge and neurological recovery were observed [ 17 ]. Thus, the SAVE trial, by confirming the equivalency of these two airway strategies in terms of ROSC and long-term outcome, consistently with the earlier AIRWAYS 2 trial [ 18 ], supports current clinical recommendations [ 14 ].…”

Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Penna

Magliocca

Merigo

et al. 2023

JCM

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Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.

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“…Network meta-analysis of randomized control trials reveal that ET tube placement and supraglottic airway (SGA) do increase the rate of ROSC compared to BVM [ 44 ]; the success rate of intubation greatly influenced the results. In one randomized clinical trial from Taipei EMS, among patients with OHCA, the initial airway management with ETI by ALS was associated with a higher probability of prehospital ROSC compared with SGA, especially among the subgroups of non-shockable rhythm, nonpublic collapse, arrested witnessed, call to airway time less than 14 minutes, and age 77 years or older, indicating that the shorter ALS response time may be related to a better chance of prehospital ROSC [ 45 ]. Chiang et al [ 23 ] also found that successful out-of-hospital intubation with OHCA patients increased the odds of sustained ROSC, survival to hospital discharge, and favorable neurological outcome compared to BVM.…”

Section: Discussionmentioning

confidence: 99%

Influence of advanced life support response time on out-of-hospital cardiac arrest patient outcomes in Taipei

et al. 2022

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Background The association between out-of-hospital cardiac arrest patient survival and advanced life support response time remained controversial. We aimed to test the hypothesis that for adult, non-traumatic, out-of-hospital cardiac arrest patients, a shorter advanced life support response time is associated with a better chance of survival. We analyzed Utstein-based registry data on adult, non-traumatic, out-of-hospital cardiac arrest patients in Taipei from 2011 to 2015. Methods Patients without complete data, witnessed by emergency medical technicians, or with response times of ≥ 15 minutes, were excluded. We used logistic regression with an exposure of advanced life support response time. Primary and secondary outcomes were survival to hospital discharge and favorable neurological outcomes (cerebral performance category ≤ 2), respectively. Subgroup analyses were based on presenting rhythms of out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation, and witness status. Results A total of 4,278 cases were included in the final analysis. The median advanced life support response time was 9 minutes. For every minute delayed in advanced life support response time, the chance of survival to hospital discharge would reduce by 7% and chance of favorable neurological outcome by 9%. Subgroup analysis showed that a longer advanced life support response time was negatively associated with the chance of survival to hospital discharge among out-of-hospital cardiac arrest patients with shockable rhythm and pulse electrical activity groups. Conclusions In non-traumatic, adult, out-of-hospital cardiac arrest patients in Taipei, a longer advanced life support response time was associated with declining odds of survival to hospital discharge and favorable neurologic outcomes, especially in patients presenting with shockable rhythm and pulse electrical activity.

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Effect of Placement of a Supraglottic Airway Device vs Endotracheal Intubation on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest in Taipei, Taiwan

Cited by 22 publications

References 21 publications

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Influence of advanced life support response time on out-of-hospital cardiac arrest patient outcomes in Taipei

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