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

Abstract

Aim This study investigated whether prehospital advanced airway management (AAM) is associated with improved survival of out‐of‐hospital cardiac arrest (OHCA) compared with conventional bag–valve–mask (BVM) ventilation. Methods We investigated the neurologically favorable survival of adult patients with OHCA who underwent BVM or AAM using the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA registry of Korea. The differences in clinical characteristics were adjusted by matching or weighting the clinical propensity for use of AAM or by least absolute shrinkage and selection operator (LASSO). The primary outcome was 30‐day survival with neurologically favorable status defined by cerebral performance category 1 or 2. Results Of the 9,616 patients enrolled (median age = 71 years; 65% male), there were 6,243 AAM and 3,354 BVM patients. In unadjusted analysis, the 30‐day neurologically favorable survival was lower in the AAM group compared with the BVM group (5.5% vs. 10.0%; hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 1.16 to 1.27; all p < 0.001). In propensity score matching–adjusted analysis, these differences were not found (9.6% vs. 10.0%; HR = 0.98, 95% CI = 0.93 to 1.03, p > 0.05). Inverse probability of treatment weighting‐ and LASSO‐adjusted analyses replicated these results. Conclusions In this nationwide real‐world data analysis of OHCA, the 30‐day neurologically favorable survival did not differ between prehospital AAM and BVM after adjustment for clinical characteristics.

Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest

“…Finally, regarding prehospital advanced airway management (AAM) in patients with OHCA[ 20 , 21 ], some studies have shown that endotracheal intubation (ETI) can improve the probability of sustained ROSC, survival to hospital discharge, and neurologic outcomes[ 22 ]. In the present study, ETI was significantly associated with P-ROSC (OR: 8.28, P < 0.001).…”

Prehospital factors associated with out-of-hospital cardiac arrest outcomes in a metropolitan city: a 4-year multicenter study

“…In a study using national data in the Republic of Korea, the prehospital AAM was 65.0%. Our city’s rate was higher than that of other countries and the domestic average [ 21 ]. However, it is not clear whether better prehospital AAM leads to better outcomes in OHCA.…”

The Utilization of Handheld Ultrasound Devices in a Prehospital Setting

“…This may be due to the fact that complicated interventions 23 are usually performed to take care of these patients during the transport; hence, physicians could not have enough time to perform POCUS. However, previous studies [24][25][26] demonstrated the feasibility and the utility of POCUS in out-of-hospital cardiac arrest patients, which showed the advantage of POCUS used.…”