Abstract 206: Effect of Airway Strategy Upon Chest Compression Quality in the Pragmatic Airway Resuscitation Trial

Abstract

Background: Chest compression (CC) quality is associated with improved out-of-hospital (OHCA) outcomes. Airway management efforts may adversely influence CC quality. We sought to compare the effects of initial laryngeal tube (LT) and initial endotracheal intubation (ETI) airway management strategies upon chest compression fraction (CCF), rate and interruptions in the Pragmatic Airway Resuscitation Trial (PART). Methods: We analyzed CPR process files collected from adult OHCA enrolled in PART. We used automated signal processing techniques (MATLAB) to identify and calculate CC quality measures. We defined a CC interruption as ≥3 second pause in chest compressions. We determined CC fraction, rate and interruptions (number and total duration) in 1-minute epochs for the entire resuscitation. We compared differences in CC quality between LT and ETI using t-tests. We repeated the analysis stratified by time before/after airway insertion as well as by successive 3-minute time segments. We also compared CC quality between single vs. multiple airway insertion attempts, as well as between BVM-only vs. ETI or LT. Results: Of 3,004 patients enrolled in PART, CPR process data were available for 1,996 (1,001 LT, 995 ETI). Mean resuscitation duration was: LT 22.6±10.8 min, ETI 25.3±11.3 min. Mean CC fraction (88% vs. 87%, p=0.045) and rate (114 vs. 114 bpm, p=0.59) were similar between LT and ETI. Median number of CC interruptions was similar between LT and ETI (11 vs. 12). Total CC interruption duration was lower for LT than ETI (160 vs. 181 sec, p=0.002); this difference was largest before airway insertion (56 vs. 78 sec, p=0.001). There were no differences in CC quality when stratified by 3-min time epochs. Total CC interruption duration was shorter for single than multiple airway insertion attempts (127 vs. 153 sec, p=0.005). Total CC interruption duration was shorter for BVM-only than LT or ETI (104 vs. 135 sec, p<0.001). Conclusion: In PART, compared with ETI, LT was associated with shorter total CC interruption duration but not other CC quality measures. Single-attempt airway insertion and BVM-only were associated with shorter total CC interruption duration. OHCA airway management may influence CC quality.