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Advanced airway management not beneficial in cardiac arrest

Among adult patients with out-of-hospital cardiac arrest (OHCA), advanced airway management is independently associated with decreased odds of a neurologically favourable survival, compared with conventional bag-valve-mask ventilation, according to a study1 published recently in the Journal of the American Medical Association.

Researchers set out to test the hypothesis that prehospital advanced airway management, such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting, is associated with favorable outcome after adult OHCA.

They analysed data from a Japanese, population-based study (All-Japan Utstein Registry) involving 649,654 consecutive adult patients who had an OHCA and in whom resuscitation was attempted by emergency responders, with subsequent transport to medical institutions, from January 2005 through December 2010. The main outcome measure was favorable neurological outcome one month after an OHCA, defined as cerebral performance category 1 or 2.

Of the eligible 649,359 patients with OHCA, 367,837 (57%) underwent bag-valve-mask ventilation and 281,522 (43%) advanced airway management, including 41,972 (6%) with endotracheal intubation and 239,550 (37%) with use of supraglottic airways. In the full cohort, the advanced airway group incurred a lower rate of favourable neurological outcome compared with the bag-valve-mask group (1.1% vs 2.9%; odds ratio [OR]).

iStock_000012168924_ExtraSmallIn multivariable logistic regression, advanced airway management had an OR for favorable neurological outcome of 0.38 after adjusting for age, sex, aetiology of arrest, first documented rhythm, witnessed status, type of bystander cardiopulmonary resuscitation, use of public access automated external defibrillator, epinephrine administration, and time intervals.

Similarly, the odds of neurologically favourable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41) and for supraglottic airways (adjusted OR, 0.38). In a propensity score–matched cohort (357,228 patients), the adjusted odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.45) and for use of supraglottic airways (adjusted OR, 0.36). Both endotracheal intubation and use of supraglottic airways were similarly associated with decreased odds of neurologically favorable survival.


1. Hasegawa K, Hiraide A, Chang Y, Brown DFM. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. J Am Med Assoc 2013;309:257–66.

Published on: January 25, 2013

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