Prehospital endotracheal intubation and survival after out-of-hospital cardiac arrest: results from the Korean nationwide registry

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• 作者：Kyung Kang ; MD^a ; ^c ; ^{Kangkyoung83@hanmail.net" class="auth_mail" title="E-mail the corresponding author} ; Taeyun Kim ; MD^a ; ^c ; ^{emkity@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Young Sun Ro ; MD^b ; ^c ; ^{blueelf7@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Yu Jin Kim ; MD^a ; ^c ; ^{myda02@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Kyung Jun Song ; MD^b ; ^c ; ^{skciva@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Sang Do Shin ; MD^b ; ^c ; ^{shinsangdo@medimail.co.kr" class="auth_mail" title="E-mail the corresponding author}
• 刊名：The American Journal of Emergency Medicine
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：34
• 期：2
• 页码：128-132
• 全文大小：350 K

文摘

Optimal out-of-hospital cardiac arrest (OHCA) airway management strategies are still controversial. Recent studies reported survival was higher among patients who received bag-valve-mask (BVM) than those receiving endotracheal intubation (ETI) or supraglottic airway (SGA). The aim of this study was to compare neurologically favorable survival outcomes among adult nontraumatic OHCA patients by prehospital airway.

Methods

We used the Korean nationwide OHCA cohort database from 2010 to 2013. The inclusion criteria were all OHCA adults with presumed cardiac etiology, resuscitated by level-1 emergency medical technician. Patients were excluded if their information about the method of prehospital airway or clinical outcomes at hospital discharge could not be captured. The primary outcome was neurologically favorable survival to discharge. We compared the outcomes among 3 groups (ETI, SGA, or BVM) by prehospital airway using multivariable logistic regression with interaction model.

Results

Of 98 896 patients with OHCA, 32 513 were included in analysis. Patients receiving BVM were 29 684 and 2829 underwent advanced airway management including 1634 with SGA and 1195 with ETI. The odds of neurologically favorable survival to discharge was significantly higher in the ETI group compared to the BVM group (adjusted OR, 1.405; 95% CI, 1.1001-1.971). In the interaction model by witnessed status, the effect of ETI on good clinical outcomes was shown only in the patients whose arrest was unwitnessed.

Conclusion

In this Korean nationwide, population-based OHCA cohort, neurologically favorable survival to hospital discharge rates was significantly higher among patients who received ETI than those receiving BVM or SGA.