- 作者：Seizan Tanabe ; MD&lowast ; ; ; Toshio Ogawa ; MSc&dagger ; ; Manabu Akahane ; MD ; PhD&dagger ; ; Soichi Koike ; MD ; PhD&Dagger ; ; Hiromasa Horiguchi ; PhD§ ; ; Hideo Yasunaga ; MD ; PhD§ ; ; Tatsuhiro Mizoguchi ; MD ; PhD¡¬ ; Tetsuo Hatanaka ; MD ; PhD¶ ; ; Hiroyuki Yokota ; MD ; PhD&lowast ; &lowast ; ; Tomoaki Imamura ; MD ; PhD&dagger ; &dagger ;
- 关键词：out-of-hospital cardiac arrest ; tracheal intubation ; supraglottic airway device ; neurological outcome ; airway management
- 刊名：Journal of Emergency Medicine
- 出版年：2013
- 出版时间：February, 2013
- 年：2013
- 卷：44
- 期：2
- 页码：389-397
- 全文大小：302 K
Background
The effect of prehospital use of supraglottic airway devices as an alternative to tracheal intubation on long-term outcomes of patients with out-of-hospital cardiac arrest is unclear.Study Objectives
We compared the neurological outcomes of patients who underwent supraglottic airway device insertion with those who underwent tracheal intubation.
Methods
We conducted a nationwide population-based observational study using a national database containing all out-of-hospital cardiac arrest cases in Japan over a 3-year period (2005-2007). The rates of neurologically favorable 1-month survival (primary outcome) and of 1-month survival and return of spontaneous circulation before hospital arrival (secondary outcomes) were examined. Multiple logistic regression analyses were performed to adjust for potential confounders. Advanced airway devices were used in 138,248 of 318,141 patients, including an endotracheal tube (ETT) in 16,054 patients (12 % ), a laryngeal mask airway (LMA) in 34,125 patients (25 % ), and an esophageal obturator airway (EOA) in 88,069 patients (63 % ).
Results
The overall rate of neurologically favorable 1-month survival was 1.03 % (1426/137,880). The rates of neurologically favorable 1-month survival were 1.14 % (183/16,028) in the ETT group, 0.98 % (333/34,059) in the LMA group, and 1.04 % (910/87,793) in the EOA group. Compared with the ETT group, the rates were significantly lower in the LMA group (adjusted odds ratio 0.77, 95 % confidence interval [CI] 0.64-0.94) and EOA group (adjusted odds ratio 0.81, 95 % CI 0.68-0.96).
Conclusions
Prehospital use of supraglottic airway devices was associated with slightly, but significantly, poorer neurological outcomes compared with tracheal intubation, but neurological outcomes remained poor overall.