Outcomes of Early versus Late Endotracheal Intubation in Patients with Initial Non-Shockable Rhythm Cardiopulmonary Arrest in the Emergency Department.

Kiattichai Daorattanachai,Winchana Srivilaithon,Vitchapon Phakawan,Intanon Imsuwan,Kee Chong Ng

doi:10.1155/2021/2112629

Kiattichai Daorattanachai, Winchana Srivilaithon + Show 3 more

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https://doi.org/10.1155/2021/2112629

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Abstract

Background Sudden cardiac arrest is a critical condition in the emergency department (ED). Currently, there is no considerable evidence supporting the best time to complete advanced airway management (AAM) with endotracheal intubation in cardiac arrest patients presented with initial non-shockable cardiac rhythm. Objectives To compare survival to hospital discharge and discharge with favorable neurological outcome between the ED cardiac arrest patients who have received AAM with endotracheal intubation within 2 minutes (early AAM group) and those over 2 minutes (late AAM group) after the start of chest compression in ED. Methods We conducted a retrospective cohort study involving the ED cardiac arrest patients who presented with initial non-shockable rhythm in ED. Multivariable logistic regression analysis was used to evaluate the independent effect of early AAM on outcomes. The outcomes included the survival to hospital discharge and discharge with favorable neurological outcome. Results There were 416 eligible participants: 209 in the early AAM group and 207 participants in the late AAM group. The early AAM group showed higher survival to hospital discharge compared with the late AAM group, but no statistically significant difference (adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.59 -2.76, p = 0.524). Discharge with favorable neurological outcome is also higher in the early AAM group (aOR: 1.68, 95% CI, 0.52 -5.45, p = 0.387). Conclusion This study did not demonstrate a significant improvement of survival to hospital discharge and discharge with favorable neurological outcome in the ED cardiac arrest patients with initial non-shockable cardiac arrest who underwent early AAM within two minutes. More research is needed on the timing of AAM and on airway management strategies to improve survival.

Highlights

Cardiac arrest is a critical condition seen in emergency departments worldwide with incidence rates of 330,000 per year in the US and 275,000 in the European Union [1].High-quality cardiopulmonary resuscitation (CPR), including effective chest compression, minimized interruption of compression, and appropriate assisted ventilation, is a crucial step in the survival of patients with cardiac arrest
Some patients need advanced airway management (AAM) with endotracheal intubation or insertion of a supraglottic airway device during CPR. e optimal method of ventilation during cardiac arrest remains controversial.According to the 2020 American Heart Association (AHA) guidelines for Emergency Medicine International cardiopulmonary resuscitation and emergency cardiovascular care, Bag-mask ventilation (BMV) or an AAM may be considered during CPR in any setting [4]
Clinical characteristics and demographic data are summarized in Table 1. e mean time of AAM in the early AAM group was 1.16 minutes (SD 0.83) compared with 5.87 minutes (SD 5.35) in the late AAM group

Summary

Background

There is no considerable evidence supporting the best time to complete advanced airway management (AAM) with endotracheal intubation in cardiac arrest patients presented with initial non-shockable cardiac rhythm. To compare survival to hospital discharge and discharge with favorable neurological outcome between the ED cardiac arrest patients who have received AAM with endotracheal intubation within 2 minutes (early AAM group) and those over 2 minutes (late AAM group) after the start of chest compression in ED. E early AAM group showed higher survival to hospital discharge compared with the late AAM group, but no statistically significant difference (adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.59 -2.76, p 0.524). Is study did not demonstrate a significant improvement of survival to hospital discharge and discharge with favorable neurological outcome in the ED cardiac arrest patients with initial non-shockable cardiac arrest who underwent early AAM within two minutes. More research is needed on the timing of AAM and on airway management strategies to improve survival

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