Abstract 9545: Airway Management and Outcomes After Out of Hospital Cardiac Arrest in the CARES Network

Abstract

Introduction: While commonly performed during out of hospital cardiac arrest (OHCA) resuscitation, the optimal airway management strategy [endotracheal intubation (ETI), supraglottic airway (SGA), or no advanced airway device] remains unclear. Hypothesis: We tested the following hypotheses: 1) ETI and SGA result in similar rates of neurologically intact OHCA survival, and 2) compared with [ETI or SGA], the use of no advanced airway device results in similar rates of neurologically intact OHCA survival. Methods: We studied adult OHCA cases from 2011 with airway management information in the Cardiac Arrest Registry to Enhance Survival (CARES), a large multicenter North American OHCA registry. Primary exposures were: 1) ETI, 2) SGA, 3) no advanced airway. Primary outcomes were: 1) sustained ROSC, 2) ED survival, 3) survival to hospital discharge, 4) neurologically intact survival to hospital discharge (cerebral performance category 1-2). We defined propensity scores to characterize the probability of receiving ETI, SGA or no advanced airway. Using multivariable random effects regression to account for clustering by EMS agency, we compared outcomes between 1) ETI vs. SGA, and 2) [no advanced airway] vs. [ETI or SGA]. We adjusted for Utstein confounders (age, sex, race, witnessed arrest, use of AED initial rhythm, public location, response time) and propensity score. Results: Of 10,691 OHCA, there were 5591 (52.6%) ETI, 3110 (29.3%) SGA, and 1929 (18.2%) with no advanced airway. Unadjusted neurologically intact survival was: ETI 5.4%, SGA 5.2% and no advanced airway 18.6%. Compared with SGA, patients receiving ETI achieved higher sustained ROSC (OR 1.35; 95% CI 1.19-1.54), ED survival (1.36; 1.19-1.55), hospital survival (1.41; 1.14-1.76) and hospital discharge with good neurologic outcome (1.44; 1.10-1.88). Compared with [ETI or SGA], patients receiving no advanced airway attained higher ED survival (1.31; 1.16-1.49), hospital survival (2.96; 2.50-3.51) and hospital discharge with good neurologic outcome (4.24; 3.46-5.20). Conclusions: OHCA in the CARES network receiving no advanced airway exhibited superior outcomes than those receiving ETI or SGA. When an advanced airway was used, ETI was associated with improved outcomes compared to SGA.