Effect of Emergency Medical Technician–Placed Combitubes on Outcomes After Out-of-Hospital Cardiopulmonary Arrest

Abstract

Objective. While emergency medical technicians–basic (EMT-Bs) in select emergency medical services (EMS) agencies use the Esophageal Tracheal Combitube (ETC) for the airway management of out-of-hospital cardiopulmonary arrests, the effect of this intervention on patient outcomes is not known. We compared the associations between initial EMT ETC placement and initial paramedic endotracheal intubation (ETI) on patient survival after out-of-hospital cardiopulmonary arrest. Methods. We utilized data on adult (age > 21 years), out-of-hospital cardiopulmonary arrests from a large, urban, county-based, two-tiered (EMT-B first responder, paramedic ambulance) EMS system for the years 1997–2005. EMT-Bs placed an ETC on cardiopulmonary arrest patients if they arrived before paramedics. Paramedics managed the airway primarily using ETI. We included cases in which rescuers accomplished ETC insertion or ETI on the first airway effort. We excluded cases in which an invasive airway was not used. We excluded cases with failed airway insertion or multiple airway efforts. We examined return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. We evaluated the association between outcome and airway type (ETC vs. ETI) using multivariate logistic regression, adjusting for age, gender, bystander-witnessed arrest, bystander cardiopulmonary resuscitation (CPR), bystander automated external defibrillator (AED) use, initial electrocardiogram (ECG) rhythm, and response time. Results. Of 7,010 adult cardiopulmonary arrests, we excluded 747 cases without airway insertion and 441 cases involving failed or multiple airway efforts. Of the remaining 5,822 cardiopulmonary arrests, 4,335 (74%) received initial paramedic ETI and 1,437 (26%) received initial EMT-B ETC insertion. Compared with paramedic ETI, EMT-B ETC placement was not associated with ROSC (adjusted odds ratio [OR] 0.93; 95% confidence interval [CI]: 0.82–1.05), survival to hospital admission (adjusted OR 0.99; 95% CI: 0.86–1.13), or survival to hospital discharge (adjusted OR 1.02; 95% CI: 0.79–1.30). Conclusions. Compared with initial paramedic ETI, initial EMT-B ETC placement was not associated with patient survival after out-of-hospital cardiac arrest.