Comparison of Advanced Airways in the Initial Airway Management of Out-of-Hospital Cardiac Arrest–Are There Any Differences?: SOS-KANTO 2012 Study Interim Report

Abstract

In Japan, emergency medical technicians (EMT) use supraglottic airway devices (SADs) or endotracheal intubation (ETI) for the initial airway management of out-of-hospital cardiac arrest (OHCA). But it is unclear that which advanced airway management method improves outcomes following OHCA. The aim of this study was to evaluate the differences of hospital admission rate after return of spontaneous circulation (ROSC) or emergency medical service (EMS) transport time among OHCA with each advanced airway management method. We enrolled all OHCA patients whom were treated by the emergency medical services (EMS) with advanced airway in KANTO area, Japan. We used the database of Survey of Survivors after Cardiac Arrest in the Kanto Area in 2012 (SOS-KANTO 2012) interim report, from Jan. 1st, 2012 to Feb. 16th, 2013. Multivariate logistic regression was applied to investigate associated factors with ROSC and evaluate the association between the type of SADs such as laryngeal mask airway (LMA) or laryngeal mask tube (LMT) or combitube, ETI and EMS out-of hospital times. We used SPSS 21 and A probability value <0.05 was considered significant. Of 6019 patients with OHCA, 2,007 were treated with SADs or ETI. EMT used LMA in 341 cases (17%), LMT in 1119 cases (55.8%), Combitube in 296 cases (14.7%), or ETI in 251 cases (12.5%). In LMT group, EMS transport times were significantly shorter than ETI group (odds ratio 4.9; 95%CI, 3.6-6.8; P<0.001). The hospital admission after ROSC was not significantly different among advanced airways. Based on our finding that hospital admission rate after ROSC was not different among advanced airways and EMS out-of hospital times were shorter in LMT group, choosing SADs instead of ETI might even lead better prognostic for the patients. LMT should be primary the choice for OHCA airway management.