103 Does Video-Assisted Laryngoscopy Improve Outcomes in Cardiac Arrest Patients Who Are Intubated Out-of-Hospital?

Abstract

Out-of-hospital intubation of cardiac arrest patients is controversial with some studies suggesting that the intubation process limits effective compressions. However, advances in video-assisted laryngoscopy (VAL) have improved the efficiency of intubation. It is unclear if the use of VAL improves outcomes in cardiac arrest patients who are intubated out-of-hospital. We sought to determine if there is improved survival to hospital admission in cardiac arrest patients who are intubated out-of-hospital using VAL versus those in whom traditional direct laryngoscopy (DL) is used. Design: Retrospective Cohort. Setting: A large suburban, two-tiered advanced life support (ALS) system that evaluates approximately 27,000 patients per year. Subjects: Consecutive patients in cardiac arrest who were intubated out-of-hospital by ALS providers over an 18-month period. Patients were divided into groups based on whether VAL or direct laryngoscopy was used as the method for intubation. ALS providers are encouraged to use VAL as the primary method of intubation, but can use DL at their discretion. We reviewed patient records to determine the intubation method used, whether the intubation was successful on the first attempt, and whether the patient survived to hospital admission. We compared the differences between the rates of survival to admission between the two groups and calculated 95% confidence intervals (CI). Out of 480 total intubations, there were 354 in the VAL group and 126 in the DL group. 64% of the VAL group and 73% of the DL group were in cardiac arrest. There were no differences in age or sex between the two groups. First attempt success rate was 76% (72, 80) in the VAL group and 84% (76, 91) in the DL group (difference 8%, CI -3, 16). Survival to hospital admission was 33% (CI: 27, 39) in the VAL group and 15% (CI: 8, 23) in the DL group. The difference in survival to hospital admission was 17% (CI: 7, 26; P < .05). Compared to DL, VAL appears to improve survival to hospital admission in cardiac arrest patients who are intubated out-of-hospital.