Abstract
BackgroundThough airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later.MethodsDuring a 6-month study period in 2010, data regarding all patients with OHCA and attempted resuscitation in southern and eastern Finland were prospectively collected. Emergency medical services (EMS) documented the airway techniques used and all adverse events related to the process. Study endpoints included the frequency of different techniques used, their success rates, methods used to verify the correct placement of the endotracheal tube, overall adverse events, and survival at hospital discharge and at follow-up a year later.ResultsA total of 614 patients were included in the study. The incidence of EMS-attempted resuscitation was determined to be 51/100,000 inhabitants per year. The final airway technique was endotracheal intubation (ETI) in 413 patients (67.3 %) and supraglottic airway device (SAD) in 188 patients (30.2 %). The overall success rate of ETI was 92.5 %, whereas that of SAD was 85.0 %. Adverse events were reported in 167 of the patients (27.2 %). Having a prehospital EMS physician on the scene (p < .001, OR 5.05, 95 % CI 2.94–8.68), having a primary shockable rhythm (p < .001, OR 5.23, 95 % CI 3.05–8.98), and being male (p = .049, OR 1.80, 95 % CI 1.00–3.22) were predictors for survival at hospital discharge.ConclusionsThis study showed acceptable ETI and SAD success rates among Finnish patients with OHCA. Adverse events related to airway management were observed in more than 25 % of patients, and overall survival was 17.8 % at hospital discharge and 14.0 % after 1 year.
Highlights
Though airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life
OHCA out-of-hospital cardiac arrest, SAD supraglottic airway device, ETI endotracheal intubation, emergency medical services (EMS) emergency medical service, EMT emergency medical technicians regression was used to identify factors related to survival at hospital discharge and at 1-year follow-up; those factors included gender, initial primary rhythm, location of cardiac arrest, witnesses, whether the even was witnessed by EMS, presumed cardiac aetiology, whether the dispatcher recognised OHCA, whether cardiopulmonary resuscitation (CPR) was provided by any bystanders before EMS arrival, the highest level of the EMS provider on the scene, ETI or SAD as the ultimate airway technique, type of region, and presence of a prehospital EMS physician in OHCA patient management
We found that placing the ETI seemed to be effective and lead to desirable results with acceptable rates; a previous survey conducted in Finland reported low frequencies of advanced airway procedures, including tracheal intubation, by non-physicians [30]
Summary
Though airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. The aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later. In Finland, emergency medical services (EMS) attempt resuscitation in 51 out-of-hospital cardiac arrests (OHCA) per 100,000 inhabitants each year [1]. Among these patients, airway management is controversial, and evidence of its role related to its outcome remains poorly documented [2, 3]. In inexperienced hands, ETI can have life-threatening consequences [10,11,12], and a prolonged procedure can even interrupt effective chest compressions during cardiac arrest [13].
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