EBQ:Japanese OHCA Prehospital Airway Management Trial

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?
• Authors hypothesized that both supraglottic and endotracheal intubation would be associated with more favorable neurologic outcomes.

Conclusion

• Advanced airway of any type was independently associated with decreased odds of neurologically favorable survival compared to BVM ventilation

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 management 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