EBQ:Japanese OHCA Prehospital Airway Management Trial

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incomplete Journal Club Article
Hasegawa, K et al. "Association of Prehospital Advanced Airway Management With Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest". JAMA. 2012. 309 (3)(187612):257–266.
PubMed Full text PDF

Clinical Question

  • Do patients with out of hospital cardiac arrest have more favorable neurological outcome with advanced airway management by EMS compared to conventional bag-valve-mask ventilation?
  • Both supraglottic and endotracheal intubation will be associated with more favorable neurologic outcomes.

Conclusion

Major Points

Inclusion Criteria

  • January 1, 2005 to December 31, 2010
  • Japanese EMS database
  • 18 years older who had out of hospital cardiac arrest
  • Resuscitation was attempted by EMS and patient was transported to hospital


Exclusion Criteria

  • no age recorded for cardiac arrest
  • out of hospital airway records were not documented

Interventions

  • advanced airway devices placed with either endotracheal intubation or supraglottic airway
  • providers had 2 attempts to place airway
  • advanced airway confirmed with end-tidal CO2 and/or esophageal detection device


Outcome

Primary Outcomes

  • favorable neurological outcome at 1 month after cardiac arrest
  • used Glasgow-Pittsburgh cerebral performance
    • Category 1 (good performance)
    • Category 2 (moderate disability)
    • Category 3 (severe disability)
    • Category 4 (vegetative state)
    • Category 5 (death)

Secondary Outcomes

  • Return of spontaneous circulation before hospital arrive
  • 1 month survival

Subgroup analysis

  • Advanced airway versus bag-valve-mask ventilation
  • Endotracheal intubation or supraglottic airway versus bag-valve-mask ventilation

Criticisms

  • Not a randomized and there is potential selection bias and confounding

Funding

References