Variability in the effects of prehospital advanced airway management on outcomes of patients with out-of-hospital cardiac arrest

Abstract

Objective To investigate variations in the effects of prehospital advanced airway management (AAM) on outcomes of out-of-hospital cardiac arrest (OHCA) patients according to regional emergency medical service (EMS) systems in four Asian cities. Methods We enrolled adult patients with EMS-treated OHCA of presumed cardiac origin between 2012 and 2014 from Osaka (Japan), Seoul (Republic of Korea), Singapore (Singapore), and Taipei (Taiwan). The main exposure variable was prehospital AAM. The primary endpoint was neurological recovery. We compared outcomes between the prehospital AAM and non-AAM groups using multivariable logistic regression with an interaction term between prehospital AAM and the four Asian cities. Results A total of 16,510 patients were included in the final analyses. The rates of prehospital AAM varied among Osaka, Seoul, Singapore, and Taipei (65.0%, 19.2%, 84.9%, and 34.1%, respectively). The non-AAM group showed better outcomes than the AAM group (adjusted odds ratio [aOR] for neurological recovery 0.30; 95% confidence interval [CI], 0.24-0.38]). In the interaction model for neurological recovery, the aORs for AAM in Osaka and Singapore were 0.12 (95% CI, 0.06-0.26) and 0.21 (95% CI, 0.16-0.28), respectively. In Seoul and Taipei, the association between prehospital AAM and neurological recovery was not significant (aOR 0.58 [95% CI, 0.31-1.10] and 0.79 [95% CI, 0.52-1.20], respectively). The interaction between prehospital AAM and region was significant (P = 0.01). Conclusion The effects of prehospital AAM on outcomes of OHCA patients differed according to regional variability in the EMS systems.

Effect of Advanced Airway Management by Paramedics During Out-of-Hospital Cardiac Arrest on Chest Compression Fraction and Return of Spontaneous Circulation

“…Differences in the style of pre-hospital rescue service and hospital transport times in countries and regions may have contributed to the variability in results. 12 In the present study, the effect of interruption of chest compressions by tracheal intubation or supraglottic airway devices was not significant, and it was proved that interruption of chest compressions by asynchronous ventilation using advanced airway devices had a more favorable effect on CCF in prehospital rescue activities in Japan.…”

Impact of different medical direction policies on prehospital advanced airway management for out-of hospital cardiac arrest patients: A retrospective cohort study

“…Another study demonstrated the significant regional variations in prehospital AAM and their effects on the outcomes of OHCA patients across four Asian EMS systems. 24 On the other hand, even in Japan, the AAM rate ranged from 27.2% to 62.1% after dividing Japan into seven geographic regions. 25 These findings can be interpreted as that the policies or strategies for prehospital AAM markedly differ according to region in Japan.…”

Nationwide population-based study of poisoning-induced out-of-hospital cardiac arrest in South Korea

“… 27 Only 19.2% of patients received AAM in South Korea. 27 The characteristics of pOHCA can affect the outcome; unlike during cardiac cause arrest, ventricular arrhythmia is low, and rapid respiratory support is required. 14 28 It can be assumed that pOHCA is related to the damage induced by the poisons that cause hypoxia in apnoea and hypercapnia; therefore, rapid CPR is needed.…”

“…These factors may be influenced by prehospital care provided by EMS. The EMS system shows variability based on regional infrastructure, which may lead to differences in the outcomes of EMS-treated OHCAs; when an OHCA occurs in the US, an average of 80% or more of patients receive advanced airway management (AAM),26 but in some parts of Asia, AAM implementation by EMS is less than 50% 27. Only 19.2% of patients received AAM in South Korea 27.…”