Variation in Out-of-Hospital Cardiac Arrest Management

Jason M Jones,Joseph A Tyndall,Christine M Van Dillen

doi:10.1155/2016/6813718

Abstract

Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA). Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%]), and one-quarter underwent three or more attempts (25/77 [25%]). One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]). Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

Highlights

More than 395,000 Americans experience out-ofhospital cardiac arrest (OHCA) [1], a condition associated with low survival rates and poor neurologic outcomes
Half of all OHCA patients received more than one airway management attempt (38/77 [49%]), and one-quarter underwent three or more attempts (25/77 [25%])
One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%])

Summary

Introduction

More than 395,000 Americans experience out-ofhospital cardiac arrest (OHCA) [1], a condition associated with low survival rates and poor neurologic outcomes. The American Heart Association’s Advanced Cardiovascular Life Support (ACLS) interventions and similar programs have been designed to provide a standardized approach to the management of cardiac arrest. Despite the increased emphasis on the precise timing of measures to improve circulation—such as chest compression, defibrillation, and drug administration—the optimal method to manage airway and breathing is left to provider preference. Paramedics responding to OHCA patients generally have three options for providing ventilation: through a bag-valvemask device, an endotracheal tube, or a supraglottic airway device (such as a King airway or laryngeal mask airway). Paramedics have limited guidance on the optimal sequence of airway selection

Methods

Results

Conclusion