Abstract 277: Supraglottic Airway Use Is Associated with Higher Chest Compression Fraction than Endotracheal Intubation During Out-of-Hospital Cardiopulmonary Arrest

Abstract

Objective: Chest compression interruptions - such as those from endotracheal intubation (ETI) - are associated with poorer out-of hospital cardiac arrest (OHCA) survival. Select Emergency Medical Services (EMS) practitioners substitute ETI with supraglottic airway (SGA) insertion to minimize these interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult OHCA receiving ETI and those receiving SGA. Methods: We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA and >2 minutes of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique and stratified these analyses by initial rhythm. We analyzed the data using t-tests and multivariable linear regression. Results: Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2,767 cases, including 2051 ETI, 671 SGA, and 45 both. Unadjusted pre- and post- airway CCF was higher for SGA than ETI (pre- 0.732 vs 0.706, difference -0.026 95% CI -0.044, -0.008; post- 0.767 vs 0.724, difference -0.043 95% CI -0.060, -0.026). Adjusted post-airway CCF improved with both techniques, but the changes were not statistically significant (0.012 difference, 95% CI 0.036, -0.012, p-value 0.32). CCF differences were similar when stratified by initial rhythm. Conclusion: In this series SGA insertion was associated with a higher CCF than ETI and that difference persisted post-airway insertion. Advanced airway management strategy may minimally impact CCF.