Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest

Wang, Henry E.; Szydlo, Daniel; Stouffer, John; Lin, Steve; Carlson, Jestin N.; Vaillancourt, Christian; Sears, Gena K.; Verbeek, Richard; Fowler, Raymond L.; Idris, Ahamed H.; Koenig, Karl; Christenson, James M.; Minokadeh, Anushirvan; Brandt, Joseph; Rea, Thomas D.

doi:10.1016/j.resuscitation.2012.05.018

Cited by 143 publications

(104 citation statements)

References 34 publications

(37 reference statements)

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“…Recent studies, however, have reported worse outcomes for out-of-hospital cardiac arrest patients managed with EADs compared to intubation, and it has been suggested that this may be attributable to neck vessel compression. 1,2,10 While the results of our small study cannot fully refute this claim, they do suggest that the compressive effect on cerebral arterial blood flow may not entirely account for the noted differences in outcome.…”

Section: Discussioncontrasting

confidence: 61%

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Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

White¹,

Braude²,

Lorenzo

et al. 2015

Academic Emergency Medicine

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Objectives: Extraglottic airway devices (EADs) are now commonly placed for airway management of critically ill or injured patients, particularly by emergency medical services providers in the out-ofhospital setting. Recent literature has suggested that EADs may cause decreased cerebral blood flow due to compression of the arteries of the neck by the devices' inflated cuffs. Methods:The authors identified a cohort of 17 patients presumed to be hemodynamically stable with EADs in place who underwent radiographic imaging of the neck. These studies were reviewed by a neuroradiologist to determine if mechanical compression of the carotid arteries was present.Results: None of the 17 cases reviewed had radiographically evident mechanical compression of the carotid artery. Conclusions:Until further studies are performed in which cerebral perfusion is evaluated prospectively in both hemodynamically stable and unstable human subjects, there is insufficicent evidence to recommend against the use of extraglottic airways in the emergency setting on the basis of carotid artery compression.ACADEMIC EMERGENCY MEDICINE 2015;22:636-638 © 2015 by the Society for Academic Emergency Medicine E xtraglottic airway devices (EADs) are commonly placed by emergency medical services (EMS) providers for airway management of critically ill or injured patients in the prehospital setting, and less commonly by physicians in the emergency department (ED). 1 Most EADs use an inflatable cuff in the hypopharynx to prevent airflow into the esophagus and to direct airflow into the trachea and lungs (see Figure 1). There exists a theoretical concern that the inflated cuffs on these devices may cause compression of the arteries in the neck that supply the brain. A recent study by Segal et al. 2 found a decrease in cerebral blood flow when EADs were used in a swine model. Colbert et al. 3 demonstrated that the laryngeal mask airway (LMA) cuff had an effect on the carotid bulb cross-sectional area and blood flow. Nandwani et al. 4 noted no sonographically evident displacement or compression of the internal jugular vein and the carotid artery in human subjects when an LMA was placed. In this study, we took advantage of a common practice at our institution in which well-functioning EADs placed in the field are left in situ for initial resuscitation and imaging in the ED. As a result, we have a number of patients who have undergone cross-sectional computed tomography (CT) studies of the cervical spine with various EADs in place. We examined whether or not mechanical carotid artery compression presumed to be secondary to the presence of the air-filled cuff in the hypopharynx was present in patients who underwent neck imaging studies and had EADs in place. We hypothesized that carotid artery compression would not be identified. METHODS Study DesignThis was a retrospective study of images acquired during usual care in our ED. This study received an exemption from our institutional review board.

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Section: Discussioncontrasting

confidence: 61%

“…1 Most EADs use an inflatable cuff in the hypopharynx to prevent airflow into the esophagus and to direct airflow into the trachea and lungs (see Figure 1). There exists a theoretical concern that the inflated cuffs on these devices may cause compression of the arteries in the neck that supply the brain.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

White¹,

Braude²,

Lorenzo

et al. 2015

Academic Emergency Medicine

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“…3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care. [4][5][6] As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care.…”

mentioning

confidence: 99%

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

McCarthy¹,

Carr²,

Sasson³

et al. 2018

Circulation

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ABSTRACT:The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation.1 Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States.2 One third of cases occur without any prior recognized heart disease; half occur without any prodromal symptoms.3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care.4-6 As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care. The American Heart Association (AHA) previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, EMS, and hospital efforts to measure and improve the process and outcome of care for patients with cardiac arrest.10 Simultaneously, the AHA proposed a national process to develop and implement evidence-based guidelines for the implementation and measurement of such systems. The 2015 AHA guidelines for CPR and emergency cardiovascular care delved deeper into the elements of an effective system of care for both OHCA and in-hospital cardiac arrest.11 This update on OHCA resuscitation systems of care describes recent advances, evidence

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“…In the ensuing discussion, it will be delineated how several under-recognized confounding variables have a major impact on the performance of this skill and even related outcomes. These variables include non-intuitive factors, such as how the EMS providers are deployed or how they have been trained to ventilate [32][33][34][35][36][37][38][39][40][41][42][43][44]. These concepts and how they relate to the success of prehospital ETI for the critically ill and injured will be addressed in the rest of this article.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Endotracheal Intubation: Elemental or Detrimental?

Pepe

Roppolo

Fowler

2015

Annual Update in Intensive Care and Emergency Medicine

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Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest

Cited by 143 publications

References 34 publications

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Prehospital Endotracheal Intubation: Elemental or Detrimental?

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