PMID- 32387124
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 1873-1570 (Electronic)
IS  - 0300-9572 (Linking)
VI  - 152
DP  - 2020 Jul
TI  - Effect of airway management strategies during resuscitation from out-of-hospital 
      cardiac arrest on clinical outcome: A registry-based analysis.
PG  - 157-164
LID - S0300-9572(20)30152-0 [pii]
LID - 10.1016/j.resuscitation.2020.04.015 [doi]
AB  - AIM: An effective airway management is pivotal for treating hypoxia and to ensure 
      reoxygenation during cardiopulmonary resuscitation (CPR). This matched-pair 
      analysis from the German Resuscitation Registry (GRR) investigates the outcomes 
      of various methods of airway management used on out-of-hospital cardiac arrest 
      (OHCA) patients. METHODS: 89,220 OHCA patients were reported between 01/01/2007 
      and 12/31/2017. After applying exclusion and inclusion criteria, the resulting 
      19,196 patient's data were analyzed. Endpoints were return of spontaneous 
      circulation (ROSC), hospital admission, 24-h survival, hospital discharge, and 
      discharge with cerebral performance categories 1,2 (CPC1,2). Three categories of 
      airway management were defined: endotracheal tube ("ETT"), laryngeal tube 
      ("LT_only"), and laryngeal to endotracheal tube exchange ("LTEX"). The groups 
      were matched with respect to age, gender, aetiology or location of OHCA, 
      witnessing or CPR by lay people, initial rhythm, and use of epinephrine and 
      amiodarone. RESULTS: "ETT" versus "LT_only" was associated with higher short- and 
      long-term outcome rates and better neurological recovery (CPC_1.2: 7.7 vs. 5.8%, 
      OR = 1.35, 95%-CI = 1.09-1.67, n = 5552). "LTEX" versus "LT_only" showed 
      significantly higher ROSC- and 24-h survival rate (33.7 vs. 21.8%, OR = 1.82, 
      95%-CI = 1.51-2.2, n = 2302). "LTEX" versus "ETT" revealed significantly higher 
      ROSC- and 24-h survival rate (34.6 vs. 30.4%, OR = 1.21, 95%-CI = 1.03-1.42, 
      n = 2608). CONCLUSION: "ETT" was associated with higher survival rates and better 
      neurological outcomes in comparison to "LT_only". The strategy of "LTEX" versus 
      "LT_only" or "ETT" was only associated with better short-term outcomes. Our 
      observational registry data suggests that endotracheal intubation by physician 
      staffed EMS is the optimal airway strategy for OHCA in our system.
CI  - Copyright (c) 2020 Elsevier B.V. All rights reserved.
FAU - Behrens, Niels-Henning
AU  - Behrens NH
AD  - Department of Anaesthesiology and Intensive Care, ALB FILS Kliniken, 
      Eichertstrasse 3, 73035 Goppingen, Germany. Electronic address: 
      niels.behrens@gmx.de.
FAU - Fischer, Matthias
AU  - Fischer M
AD  - Department of Anaesthesiology and Intensive Care, ALB FILS Kliniken, 
      Eichertstrasse 3, 73035 Goppingen, Germany.
FAU - Krieger, Tobias
AU  - Krieger T
AD  - Emergency Department, University Hospital of Duesseldorf, Moorenstrasse 5, 40225 
      Duesseldorf, Germany.
FAU - Monaco, Kathleen
AU  - Monaco K
AD  - Emergency Department, University Hospital of Duesseldorf, Moorenstrasse 5, 40225 
      Duesseldorf, Germany.
FAU - Wnent, Jan
AU  - Wnent J
AD  - University Hospital Schleswig-Holstein, Department of Anaesthesiology and 
      Intensive Care Medicine, Arnold-Heller-Str. 3, 24105 Kiel, Germany; University of 
      Namibia, School of Medicine, Windhoek, Namibia; University Hospital 
      Schleswig-Holstein, Institute for Emergency Medicine, Arnold-Heller-Str. 3, 24105 
      Kiel, Germany.
FAU - Seewald, Stephan
AU  - Seewald S
AD  - University Hospital Schleswig-Holstein, Department of Anaesthesiology and 
      Intensive Care Medicine, Arnold-Heller-Str. 3, 24105 Kiel, Germany; University 
      Hospital Schleswig-Holstein, Institute for Emergency Medicine, Arnold-Heller-Str. 
      3, 24105 Kiel, Germany.
FAU - Grasner, Jan-Thorsten
AU  - Grasner JT
AD  - University Hospital Schleswig-Holstein, Department of Anaesthesiology and 
      Intensive Care Medicine, Arnold-Heller-Str. 3, 24105 Kiel, Germany; University 
      Hospital Schleswig-Holstein, Institute for Emergency Medicine, Arnold-Heller-Str. 
      3, 24105 Kiel, Germany.
FAU - Bernhard, Michael
AU  - Bernhard M
AD  - Emergency Department, University Hospital of Duesseldorf, Moorenstrasse 5, 40225 
      Duesseldorf, Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200505
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
MH  - Airway Management
MH  - *Cardiopulmonary Resuscitation
MH  - *Emergency Medical Services
MH  - Humans
MH  - Intubation, Intratracheal
MH  - *Out-of-Hospital Cardiac Arrest/therapy
MH  - Registries
OTO - NOTNLM
OT  - Airway management
OT  - Cardiopulmonary resuscitation
OT  - Endotracheal intubation
OT  - Matched-pair analysis
OT  - Out-of-hospital cardiac arrest
EDAT- 2020/05/11 06:00
MHDA- 2021/06/22 06:00
CRDT- 2020/05/11 06:00
PHST- 2019/09/29 00:00 [received]
PHST- 2020/04/04 00:00 [revised]
PHST- 2020/04/13 00:00 [accepted]
PHST- 2020/05/11 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/05/11 06:00 [entrez]
AID - S0300-9572(20)30152-0 [pii]
AID - 10.1016/j.resuscitation.2020.04.015 [doi]
PST - ppublish
SO  - Resuscitation. 2020 Jul;152:157-164. doi: 10.1016/j.resuscitation.2020.04.015. 
      Epub 2020 May 5.