SUPRAGLOTTIC AIRWAY PLACEMENT REDUCES TIME TO ADVANCED AIRWAY DURING IN-HOSPITAL CARDIAC ARREST

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Airway assessment is integral to advanced cardiac life support (ACLS). Cardiac arrests in the intensive care unit (ICU) may facilitate rapid advanced airway placement owing to more staff and proximity of intensivists. Inpatient floors are more challenging however, as staff experienced in rapid advanced airway placement are not immediately available. Our institution, a 914 bed quaternary care referral center, previously relied on certified registered nurse anesthetists (CRNAs) to perform endotracheal intubation during non-ICU in-hospital cardiac arrests (ICHAs). In an effort to shorten the time to establish an airway in non-ICU ICHAs, our respiratory therapy department hypothesized that allowing rapid-response respiratory therapists (RRTs) to insert a supraglottic airway during ICHAs should decrease the time between ICHA announcement and placement of an advanced airway. Previous studies have not shown a difference between supra- and subglottic airways and markers of ventilation/perfusion or outcomes in out-of-hospital cardiac arrests. METHODS: In October of 2018, supraglottic airway training and education on inclusion/exclusion criteria was performed. Inclusion criteria: unconscious non-ICU patients experiencing IHCA. Exclusion criteria: consciousness, trismus, pharyngo-perilaryngeal trauma or mass. Subsequently, a project was approved by the institution’s code blue committee that allowed RRTs to insert supraglottic airways (i-gel® Intersurgical) in patients suffering an IHCA on inpatient floors. Data was collected on 12 IHCAs over 5 months, including arrest time, time to supraglottic airway placement, and time to subglottic intubation (if performed). For comparison, data on length of time from IHCA to intubation was collected on 12 randomly selected non-ICU ICHAs prior to 2018. RESULTS: Prior to supraglottic airway use, the average time from ICHA announcement to intubation was 15.33 minutes (range 4-38 minutes). After initiation of the supraglottic airway project, average time from ICHA to supraglottic airway was 4.7 minutes (range 1-7 minutes). For those intubated after supraglottic airway placement, the average time from IHCA to subglottic intubation was 17.6 minutes (range 10-30 minutes). During this project, no dislodgements of the supraglottic airway or aspiration events occurred. In all cases, the ACLS protocol based on American Heart Association guidelines was followed with no complications noted. CONCLUSIONS: Empowerment of RRTs to insert a supraglottic airway significantly reduces time between IHCA and advanced airway placement. More research is needed to determine correlation between time to advanced airway and immediate survival, survival to hospital discharge, and neurologic sequelae. CLINICAL IMPLICATIONS: This study demonstrates that an advanced airway can be established during IHCA without having to wait for personnel experienced in endotracheal intubation. DISCLOSURES: No relevant relationships by Idrees Mogri, source=Web Response No relevant relationships by Adan (Adam) Mora, source=Web Response No relevant relationships by Robert Ritchey, source=Web Response No relevant relationships by Rahul Sawhney, source=Web Response No relevant relationships by Mark Whitford, source=Web Response