Effect of Pre-Hospital Advanced Airway Management for Out-Of-Hospital Cardiac Arrest Caused by Respiratory Disease: A Propensity Score–Matched Study

Abstract

Optimal pre-hospital care for out-of-hospital cardiac arrest (OHCA) caused by respiratory disease may differ from that for OHCA associated with other aetiologies, especially with respect to respiratory management. We aimed to investigate whether pre-hospital advanced airway management (AAM) was associated with favourable outcomes after OHCA caused by intrinsic respiratory disease. This nationwide, population-based, propensity score-matched study of adult patients in Japan with OHCA due to respiratory disease from 1 January 2005 to 31 December 2012 compared patients with and without pre-hospital AAM. The primary outcome was neurologically favourable survival at one month after the OHCA. Of 49,534 eligible patients, 20,458 received pre-hospital AAM and 29,076 did not. In a propensity score-matched cohort (18,483 versus 18,483 patients), the odds of neurologically favourable survival were significantly lower for patients receiving pre-hospital AAM (0.6% versus 1.5%; odds ratio [OR] 0.42 [95% confidence interval {CI} 0.34 to 0.52]). The results from multivariable logistic regression analysis also showed that pre-hospital AAM was significantly associated with a decreased chance of neurologically favourable survival (adjusted OR 0.43 [95% CI 0.35 to 0.52]). Similar findings were observed for one-month survival and pre-hospital return of spontaneous circulation. In subgroup analyses, pre-hospital AAM was associated with poor neurological outcomes, regardless of the type of airway device used (laryngeal mask airway, adjusted OR 0.35 [95% CI 0.19 to 0.57]; oesophageal obturator airway, adjusted OR 0.44 [95% CI 0.35 to 0.55]; and endotracheal tube, adjusted OR 0.47 [95% CI 0.30 to 0.69]). In conclusion, pre-hospital AAM was associated with poor neurological outcome among patients with OHCA caused by intrinsic respiratory disease.

Association between prehospital airway management methods and neurologic outcome in out-of-hospital cardiac arrest with respiratory cause: a nationwide retrospective observational study

“…A previous study reported negative association between prehospital advanced airway management and neurologic outcome of OHCA [15], we believe there are two different points between the study and our study. First, patient population of two studies was different because criteria used to define respiratory disease were different.…”

“…Several previous studies have reported negative effects of prehospital advanced airway placement on the outcome of respiratory cardiac arrest [15,24]. However, these studies included only limited number of patients with medical intrinsic respiratory disease, excluding external causes of arrest, such as asphyxia or hanging.…”

“…The main purpose of advanced airway placement is to provide more effective oxygenation and ventilation than basic airway such as bag-valve-mask (BVM) [9,10]. Various studies have compared the effects of prehospital advanced airway management methods on outcomes in OHCA, but they are mostly tested in cardiac arrest with presumed cardiac cause the results are still controversial [11][12][13][14][15]. However, little is known about the association of prehospital advanced airway management and outcome according to the cause of cardiac arrest.…”

Association Between Prehospital Airway Management Methods and Neurologic Outcome in Out-Of-Hospital Cardiac Arrest (OHCA) with Respiratory Cause.

“…(9,10) Various studies have compared the effects of prehospital advanced airway management methods on outcomes in OHCA, but they are mostly tested in cardiac arrest with presumed cardiac cause the results are still controversial. (11)(12)(13)(14)(15) Difference in bystander response, prehospital epinephrine administration and clinical outcome between arrests caused by respiratory and cardiac cause have been reported in other studies. (16)(17)(18) However, little is known about the association of prehospital advanced airway management and outcome according to the cause of cardiac arrest.…”

“…(26) Several previous studies have reported negative effects of prehospital advanced airway placement on the outcome of respiratory cardiac arrest. (15,18) However, these studies included only limited number of patients with medical intrinsic respiratory disease, excluding external causes of arrest, such as asphyxia or hanging. Additionally, the studies only tested the overall effect of prehospital advanced airway rather than the effect of each advanced airway method according to different etiologies, as in our study.…”