Out-of-hospital airway management during manual compression or automated chest compression devices

Bernhard, Michaël; Behrens, N. H.; Wnent, Jan; Seewald, Stephan; Brenner, Sigrid; Jantzen, Tanja; Böhn, Andreas; Gräsner, Jan–Thorsten; Fischer, Matthias

doi:10.1007/s00101-017-0401-6

Cited by 20 publications

(10 citation statements)

References 33 publications

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“…Twenty-three studies (n=397,158) investigated the effect of advanced airway management on ROSC showing a significant increase with ETT (OR= 1.44; 95%CI= 1.27 to 1.63; I 2 = 91%; p<0.00001; Table 2) [7,75].…”

Section: C E P T E D M a N U S C R I P Tmentioning

confidence: 99%

“…Interestingly, the only management related sensitivity analysis to show a significant benefit without heterogeneity was in the presence of concurrent automated chest compressions. This is important given the increasing popularity of automated compression devices for both in and out of hospital cardiac arrest [7,50]. This subgroup analysis was only able to be performed on short term outcomes (ROSC and survival to admission).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…ETT intubation is traditionally considered a definitive airway, although greater skill is required for its placement and the process of securing the airway may be associated with unrecognized misplacement of the tube, increased number of attempts and interruptions to chest compressions [3,4]. Since previous meta-analyses [5], a number of studies have renewed interest in establishing optimal airway management strategies for OHCA [6][7][8].…”

Section: Accepted Manuscript Introductionmentioning

confidence: 99%

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Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis

White

Melhuish

Holyoak

et al. 2018

The American Journal of Emergency Medicine

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Objectives: To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway(SGA) devices used during out-of-hospital cardiac arrest(OHCA). Methods: A systematic search of five databases was performed by two independent reviewers until September 2018. Included studies reported on (1) OHCA or cardiopulmonary resuscitation, and (2) endotracheal intubation versus supraglottic airway device intubation. Exclusion criteria (1) stimulation studies, (2) selectively included/excluded patients, (3)in-hospital cardiac arrest. Odds Ratios (OR) with random effect modelling was used. Primary outcomes: (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, (4) discharge with a neurologically intact state. Results: Twenty-nine studies (n=539,146) showed that overall, ETT use resulted in a heterogeneous, but significant increase in ROSC (OR=1.44; 95% CI=1.27 to 1.63; I 2 =91%; p<0.00001) and survival to admission (OR=1.36; 95%CI=1.12 to 1.66; I 2 =91%; p=0.002). There was no significant difference in survival to discharge or neurological outcome(p>0.0125). On sensitivity analysis of RCTs, there was no significant difference in ROSC , survival to admission, survival to discharge or neurological outcome (p>0.0125). On analysis of automated chest compression, without heterogeneity, ETT provided a significant increase in ROSC (OR=1.55; 95%CI=1.20 to 2.00; I 2 =0%; p=0.0009) and survival to admission (OR=2.16; 95%CI=1.54 to 3.02; I 2 =0%; p<0.00001). Conclusions: The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in survival or neurological outcome. In the presence of automated chest compressions, ETT intubation may result in survival benefits.

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Section: C E P T E D M a N U S C R I P Tmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscript Introductionmentioning

confidence: 99%

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Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis

White

Melhuish

Holyoak

et al. 2018

The American Journal of Emergency Medicine

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“…For instance, effective airway and ventilation strategies when a chest compression device is applied are missing [22]. Therefore, the dataset includes information on airway device, capnography and measurements for pCO2, pO2 and Hb from the first blood gas analysis after hospital admission.…”

Section: Discussionmentioning

confidence: 99%

Differences between manual CPR and corpuls cpr in regard to quality and outcome: study protocol of the comparing observational multi‐center prospective registry study on resuscitation (COMPRESS)

Seewald

Dopfer

Wnent

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The effect of mechanical CPR is diversely described in the literature. Different mechanical CPR devices are available. The corpuls cpr is a new generation of piston-driven devices and was launched in 2015. The COMPRESS-trial analyzes quality of chest compression and CPR-related injuries in cases of mechanical CPR by the corpuls cpr and manual CPR. Methods This article describes the design and study protocol of the COMPRESS-trial. This observational multi-center study includes all patients who suffered an out-of-hospital cardiac arrest (OHCA) where CPR is attempted in four German emergency medical systems (EMS) between January 2020 and December 2022. EMS treatment, in-hospital-treatment and outcome are anonymously reported to the German Resuscitation Registry (GRR). This information is linked with data from the defibrillator, the feedback system and the mechanical CPR device for a complete dataset. Primary endpoint is chest compression quality (complete release, compression rate, compression depth, chest compression fraction, CPR-related injuries). Secondary endpoint is survival (return of spontaneous circulation (ROSC), admission to hospital and survival to hospital discharge). The trial is sponsored by GS Elektromedizinische Geräte G. Stemple GmbH. Discussion This observational multi-center study will contribute to the evaluation of mechanical chest compression devices and to the efficacy and safety of the corpuls cpr. Trial registration DRKS, DRKS-ID DRKS00020819. Registered 31 July 2020.

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Section: Accepted Manuscript Introductionmentioning

confidence: 99%

Advanced airway management in out of hospital cardiac arrest: A Systematic Review and Meta-Analysis

Vlok¹

2018

WaggaJOM

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Objectives: To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway(SGA) devices used during out-of-hospital cardiac arrest(OHCA). Methods:A systematic search of five databases was performed by two independent reviewers until September 2018. Included studies reported on (1) OHCA or cardiopulmonary resuscitation, and (2) endotracheal intubation versus supraglottic airway device intubation. Exclusion criteria (1) stimulation studies, (2) selectively included/excluded patients, (3)in-hospital cardiac arrest. Odds Ratios (OR) with random effect modelling was used. Primary outcomes: (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, (4) discharge with a neurologically intact state.Results: Twenty-nine studies (n=539,146) showed that overall, ETT use resulted in a heterogeneous, but significant increase in ROSC (OR=1.44; 95% CI=1.27 to 1.63; I 2 =91%; p<0.00001) and survival to admission (OR=1.36; 95%CI=1.12 to 1.66; I 2 =91%; p=0.002). There was no significant difference in survival to discharge or neurological outcome(p>0.0125). On sensitivity analysis of RCTs, there was no significant difference in ROSC , survival to admission, survival to discharge or neurological outcome (p>0.0125). On analysis of automated chest compression, without heterogeneity, ETT provided a significant increase in ROSC (OR=1.55; 95%CI=1.20 to 2.00; I 2 =0%; p=0.0009) and survival to admission (OR=2.16; 95%CI=1.54 to 3.02; I 2 =0%; p<0.00001). Conclusions:The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in survival or neurological outcome. In the presence of automated chest compressions, ETT intubation may result in survival benefits.

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Out-of-hospital airway management during manual compression or automated chest compression devices

Cited by 20 publications

References 33 publications

Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis

Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis

Differences between manual CPR and corpuls cpr in regard to quality and outcome: study protocol of the comparing observational multi‐center prospective registry study on resuscitation (COMPRESS)

Advanced airway management in out of hospital cardiac arrest: A Systematic Review and Meta-Analysis

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