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
PubMed Full text PDF
Contents
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
Authors:
Michael Holtz, Daniel Ostermayer, Alison Panosian, Ross Donaldson