scholarly journals Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Tomas Henlin ◽  
Pavel Michalek ◽  
Tomas Tyll ◽  
John D. Hinds ◽  
Milos Dobias
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Negative Impact ◽  
Survival Rates ◽  
Early Stages ◽  
Published Evidence ◽  
Bag Mask Ventilation ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

scholarly journals Association between prehospital airway management methods and neurologic outcome in out-of-hospital cardiac arrest with respiratory cause: a nationwide retrospective observational study

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Interaction Analysis ◽  
Neurologic Outcome ◽  
Supraglottic Airway ◽  
Neurologic Recovery ◽  
Logistic Regression Models ◽  
Advanced Airway ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Cardiac arrests are resulted by various aetiology including respiratory cause. Advanced airway placement is an important prehospital intervention for oxygenation and ventilation in respiratory cardiac arrest. We evaluated the association between of advanced airway method and neurologic outcome in arrest with respiratory cause. Adult witnessed non-traumatic OHCA (out-of-hospital cardiac arrest) treated by emergency medical service (EMS) providers in 2013–2017 were enrolled in a nationwide OHCA database. The association between airway management methods (endotracheal intubation (ETI), supraglottic airway (SGA) and bag valve mask (BVM)) and outcome were evaluated according to the presumed cause of cardiac arrest (cardiac, respiratory or others). The primary outcome was good neurological recovery at discharge. Multivariable logistic regression models with interaction analysis was conducted. Of 40,443 eligible OHCA patients, the cause of arrest of 90.0%, 7.5%, and 2.4% of patients were categorized as cardiac, respiratory and others, respectively. There were no statistically significant differences in the effect of the advanced airway type on good neurologic recovery in the total population (adjusted odds ratio (aOR) 0.96 (0.81–1.14) for ETI; 1.01 (95% confidence intervals (CI) 0.93–1.11) for BVM). However, ETI was associated with better neurologic recovery than SGA or BVM in OHCA in cardiac arrest with suspected respiratory cause (aOR 3.12 (95% CI 1.24–7.80) for ETI; 0.99 (95% CI 0.51–1.91) for BVM). Prehospital ETI was associated with good neurologic outcome when the cause of arrest was respiratory. ETI may be considered initially when a respiratory cause is suspected on the scene.

Abstract 163: Type of Prehospital Airway Management Does Not Affect Chest X-Ray Abnormality in Resuscitated Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hiromichi Naito ◽  
Atsunori Nakao ◽  
Alexandra Weissman ◽  
Jonathan Elmer ◽  
Christian Martin-Gill ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Supraglottic Airway ◽  
Positive Pressure ◽  
Thoracic Imaging ◽  
X Ray ◽  
Significant Difference ◽  
Chest X Ray ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Introduction: Chest x-ray (CXR) abnormalities after cardiopulmonary resuscitation are common. Mechanisms by which these abnormalities develop are not fully elucidated, but aspiration of secretions and regurgitated gastric contents during prehospital airway management may be an important modifiable cause. Hypothesis: We hypothesized that endotracheal intubation (ETI) is associated with decreased incidence of CXR abnormalities after out-of-hospital cardiac arrest (OHCA), as compared to bag-valve-mask (BVM) or supraglottic airway (SGA) use. Methods: We conducted a retrospective review including resuscitated OHCA patients treated at a single academic medical center from 2010-2015. We included patients that had an initial CXR obtained within 66 hours of arrival. We excluded patients with tracheostomy, patients without positive pressure ventilation on emergency department (ED) arrival, or missing initial airway management data. We classified patients by airway management at the time of ED arrival into three groups: BVM, SGA, and ETI. Board certified thoracic imaging radiologists determined if there was any CXR abnormality, and if the observed abnormality was likely due to aspiration. The incidence of any abnormality and aspiration were compared between groups. A multivariable logistic regression model was used to adjust for baseline clinical characteristics. Results: Of the 766 subjects included in the study, 22 (3%) had BVM, 68 (9%) had SGA, and 676 (88%) had ETI. Most 58% were male, 34% had initial rhythm VF/VT, and 61% had a witnessed arrest. Any abnormality on CXR was identified in 543 (71%) cases, and likely aspiration was observed in 205 (27%) cases. Incidence of CXR abnormality was not significantly different between groups: BVM group 18/22 (82%), reference; SGA group 52/68 (76%), OR 0.75, 95% CI 0.13-4.31; ETI group 473/676 (70%), OR 0.81, 95% CI 0.16-4.01. Incidence of aspiration on CXR was also not different between groups: BVM group 6/22 (27%), reference; SGA group 19/68 (28%), OR 1.04, 95% CI 0.18-6.22; ETI group 180/676 (27%), OR 1.26, 95% CI 0.25-6.32. Conclusion: Prehospital airway management strategy for resuscitated OHCA patients was not associated with a significant difference in the incidence of any abnormality or aspiration on CXR.

scholarly journals Confirmed cardiac output on emergency medical services arrival as confounding by indication: an observational study of prehospital airway management in patients with out-of-hospital cardiac arrest

2019 ◽  
pp. emermed-2018-208107 ◽  
Author(s):  
Atsushi Sakurai ◽  
Kosaku Kinoshita ◽  
Yukihiro Maeda ◽  
Yosuke Homma ◽  
Yoshio Tahara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Output ◽  
Airway Management ◽  
Emergency Medical Services ◽  
Neurological Outcome ◽  
Medical Services ◽  
Confounding By Indication ◽  
Emergency Medical ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

ObjectivesMany registry studies on patients with out-of-hospital cardiac arrest (OHCA) have reported that conventional bag-valve-mask (BVM) ventilation is independently associated with favourable outcomes. This study aimed to compare the data of patients with OCHA with confirmed cardiac output on emergency medical services (EMS) arrival and consider the confounding factors in prehospital airway management studies.MethodsThis was a cohort study using the registry data for survivors after out-of hospital cardiac arrest in the Kanto region at 2012 in Japan (SOS-KANTO 2012). Survivors who received advanced airway management (AAM) group and a BVM group were compared for confirmed cardiac output on EMS arrival and neurolgical outcome at 1 month. Favourable neurological outcome was defined as a score of one or two on the Cerebral Performance Categories Scale. Multivariable logistic regression was used to adjust the neurological outcome by age, gender, cardiac aetiology, witnessed arrest, shockable rhythm, cardiopulmonary resuscitation performed by a bystander, BVM at prehospital ventilation and presence of confirmed cardiac output on EMS arrival.ResultsA total of 16 452 patients were enrolled in the SOS-KANTO 2012 study, and of those data 12 867 were analysed; 5893 patients comprised the AAM group and 6974 comprised the BVM group. Of the study participants, 386 (2.9%) had confirmed cardiac output on EMS arrival; 340 (2.6%) of the entire study group had a favourable neurological outcome. The proportion of patients with confirmed cardiac output on EMS arrival was significantly higher in the BVM group (272: 3.9%) than in the AAM group (114: 1.9%) (95% CI: 1.65 to 2.25). The proportion of patients with favourable neurological outcomes was 30% (117/386) in those with cardiac output on EMS arrival compared with 1.8% (223/12481) in those without. The OR for a good neurological outcome with BVM decreased from 3.24 (2.49 to 4.20) to 2.60 (1.97 to 3.44) when confirmed cardiac output on EMS arrival was added to the multivariable model analysis.ConclusionConfirmed cardiac output on EMS arrival should be considered as confounding by indication in observational studies of prehospital airway management.

scholarly journals Early-Onset Pneumonia in Non-Traumatic Out-of-Hospital Cardiac Arrest Patients with Special Focus on Prehospital Airway Management

2016 ◽  
Vol 22 ◽  
pp. 2013-2020 ◽  
Author(s):  
Martin Christ ◽  
Katharina Isabel von Auenmueller ◽  
Scharbanu Amirie ◽  
Benjamin Michel Sasko ◽  
Michael Brand ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Early Onset ◽  
Special Focus ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Prehospital Airway Management for Out-of-Hospital Cardiac Arrest—Reply

JAMA ◽  
2013 ◽  
Vol 309 (18) ◽  
pp. 1888
Author(s):  
Kohei Hasegawa ◽  
Atsushi Hiraide ◽  
David F. M. Brown
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Prehospital Airway Management for Out-of-Hospital Cardiac Arrest

JAMA ◽  
2013 ◽  
Vol 309 (18) ◽  
pp. 1888 ◽  
Author(s):  
Michael Bernhard ◽  
Torben K. Becker ◽  
Bernd W. Böttiger
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

scholarly journals The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: A propensity score matched analysis

2017 ◽  
Vol 7 (5) ◽  
pp. 423-431 ◽  
Author(s):  
Patrick Sulzgruber ◽  
Philip Datler ◽  
Fritz Sterz ◽  
Michael Poppe ◽  
Elisabeth Lobmeyr ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Cardiac Arrest ◽  
Propensity Score ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Survival Rates ◽  
Laryngeal Tube ◽  
Supraglottic Airway ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background: While guidelines mentioned supraglottic airway management in the case of out-of- hospital cardiac arrest, robust data of their impact on the patient outcome remain scare and results are inconclusive. Methods: To assess the impact of the airway strategy on the patient outcome we prospectively enrolled 2224 individuals suffering cardiac arrest who were treated by the Viennese municipal emergency medical service. To control for potential confounders, propensity score matching was performed. Patients were matched in four groups with a 1:1:1:1 ratio ( n=210/group) according to bag-mask-valve, laryngeal tube, endotracheal intubation and secondary endotracheal intubation after primary laryngeal tube ventilation. Results: The laryngeal tube subgroup showed the lowest 30-day survival rate among all tested devices ( p<0.001). However, in the case of endotracheal intubation after primary laryngeal tube ventilation, survival rates were comparable to the primary endotracheal tube subgroup. The use of a laryngeal tube was independently and directly associated with mortality with an adjusted odds ratio of 1.97 (confidence interval: 1.14–3.39; p=0.015). Additionally, patients receiving laryngeal tube ventilation showed the lowest rate of good neurological performance (6.7%; p<0.001) among subgroups. However, if patients received endotracheal intubation after initial laryngeal tube ventilation, the outcome proved to be significantly better (9.5%; p<0.001). Conclusion: We found that the use of a laryngeal tube for airway management in cardiac arrest was significantly associated with poor 30-day survival rates and unfavourable neurological outcome. A primary endotracheal airway management needs to be considered at the scene, or an earliest possible secondary endotracheal intubation during both pre-hospital and in-hospital post-return of spontaneous circulation critical care seems crucial and most beneficial for the patient outcome.

scholarly journals Airway management during in-hospital cardiac arrest in adults: UK national survey and interview study with anaesthetic and intensive care trainees

2020 ◽  
pp. 175114372094945
Author(s):  
Laura Goodwin ◽  
Katie Samuel ◽  
Behnaz Schofield ◽  
Sarah Voss ◽  
Stephen J Brett ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Online Survey ◽  
Management Strategies ◽  
Randomised Trial ◽  
Care Staff ◽  
The Uk ◽  
Hospital Cardiac Arrest

Background The optimal airway management strategy for in-hospital cardiac arrest is unknown. Methods An online survey and telephone interviews with anaesthetic and intensive care trainee doctors identified by the United Kingdom Research and Audit Federation of Trainees. Questions explored in-hospital cardiac arrest frequency, grade and specialty of those attending, proportion of patients receiving advanced airway management, airway strategies immediately available, and views on a randomised trial of airway management strategies during in-hospital cardiac arrest. Results Completed surveys were received from 128 hospital sites (76% response rate). Adult in-hospital cardiac arrests were attended by anaesthesia staff at 40 sites (31%), intensive care staff at 37 sites (29%) and a combination of specialties at 51 sites (40%). The majority (123/128, 96%) of respondents reported immediate access to both tracheal intubation and supraglottic airways. A bag-mask technique was used ‘very frequently’ or ‘frequently’ during in-hospital cardiac arrest by 111/128 (87%) of respondents, followed by supraglottic airways (101/128, 79%) and tracheal intubation (69/128, 54%). The majority (60/100, 60%) of respondents estimated that ≤30% of in-hospital cardiac arrest patients undergo tracheal intubation, while 34 (34%) estimated this to be between 31% and 70%. Most respondents (102/128, 80%) would be ‘likely’ or ‘very likely’ to recruit future patients to a trial of alternative airway management strategies during in-hospital cardiac arrest. Interview data identified several barriers and facilitators to conducting research on airway management in in-hospital cardiac arrest. Conclusions There is variation in airway management strategies for adult in-hospital cardiac arrest across the UK. Most respondents would be willing to take part in a randomised trial of airway management during in-hospital cardiac arrest.

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