EBQ:Japanese OHCA Prehospital Airway Management Trial: Difference between revisions
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==Clinical Question== | ==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? | |||
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. | ||
Both supraglottic and endotracheal intubation will be associated with more favorable neurologic outcomes. | |||
==Conclusion== | ==Conclusion== | ||
==Major Points== | ==Major Points== | ||
==Inclusion Criteria== | ==Inclusion Criteria== | ||
*January 1, 2005 to December 31, 2010 | *January 1, 2005 to December 31, 2010 | ||
*Japanese EMS database | *Japanese EMS database | ||
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==Exclusion Criteria== | ==Exclusion Criteria== | ||
*no age recorded for cardiac arrest | *no age recorded for cardiac arrest | ||
*out of hospital airway records were not documented | *out of hospital airway records were not documented | ||
==Interventions== | ==Interventions== | ||
*advanced airway devices placed with either endotracheal intubation or supraglottic airway | *advanced airway devices placed with either endotracheal intubation or supraglottic airway | ||
*providers had 2 attempts to place airway | *providers had 2 attempts to place airway | ||
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===Primary Outcomes=== | ===Primary Outcomes=== | ||
*favorable neurological outcome at 1 month after cardiac arrest | *favorable neurological outcome at 1 month after cardiac arrest | ||
*used Glasgow-Pittsburgh cerebral performance | *used Glasgow-Pittsburgh cerebral performance | ||
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===Secondary Outcomes=== | ===Secondary Outcomes=== | ||
*Return of spontaneous circulation before hospital arrive | *Return of spontaneous circulation before hospital arrive | ||
*1 month survival | *1 month survival | ||
===Subgroup analysis=== | ===Subgroup analysis=== | ||
*advanced airway versus bag-valve-mask ventilation | *advanced airway versus bag-valve-mask ventilation | ||
*endotracheal intubation or supraglottic airway versus bag-valve-mask ventilation | *endotracheal intubation or supraglottic airway versus bag-valve-mask ventilation | ||
==Criticisms== | ==Criticisms== | ||
*not a randomized and there is potential selection bias and confounding | *not a randomized and there is potential selection bias and confounding | ||
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== | ==References== | ||
Revision as of 18:57, 6 July 2017
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
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