EBQ:Japanese OHCA Prehospital Airway Management Trial: Difference between revisions
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==Interventions== | ==Interventions== | ||
* | *Advanced airway devices placed by EMTs | ||
* | **Endotracheal intubation | ||
* | **Supraglottic airway | ||
***Laryngeal mask airway, laryngeal tube, or esophageal-tracheal twin lumen airway device | |||
*Providers had 2 attempts to place airway device | |||
*Advanced airway confirmed with end-tidal CO2 and/or esophageal detection device | |||
==Outcome== | ==Outcome== | ||
Revision as of 15:13, 14 October 2019
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?
- 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
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 management not documented
Interventions
- Advanced airway devices placed by EMTs
- Endotracheal intubation
- Supraglottic airway
- Laryngeal mask airway, laryngeal tube, or esophageal-tracheal twin lumen airway device
- Providers had 2 attempts to place airway device
- 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