Airway Management In Cardiac Arrest Research Articles

Con: We Should Not Routinely Intubate All Patients in Cardiac Arrest

The International Liaison Committee on Resuscitation (ILCOR) and the European Resuscitation Council (ERC) advocate a stepwise approach to airway management in cardiac arrest and if an advanced airway is required, proficient practitioners should preferentially employ tracheal intubation.1 Whilst there are numerous benefits to placement of a tracheal tube (TT), there are foreseeable situations in which tracheal intubation is not necessary and arguably there may be some benefit in alternative airway management, at least during initial resuscitation. This author proposes that even for the advanced responder, as anesthesiologists and intensive care physicians, the decision to site a TT should not be routine and should instead be reserved for select cases.

Endotracheal intubation-still the gold standard in out-of-hospital cardiac arrest airway management?

Endotracheal intubation-still the gold standard in out-of-hospital cardiac arrest airway management?

Endotracheal intubation during out-of-hospital cardiac arrest: New insights from recent clinical trials.

Airway management is an important intervention during resuscitation of out‐of‐hospital cardiac arrest (OHCA). Endotracheal intubation is commonly used by emergency medical services paramedics in the advanced airway management of OHCA, but numerous studies question its safety and effectiveness. Furthermore, there is now increasing use of supraglottic airway devices. In this review, we provide an overview of 3 recent randomized clinical trials of advanced airway management (Pragmatic Airway Resuscitation Trial [PART], AIRWAYS‐2, and Cardiac Arrest Airway Management [CAAM]) and highlight new information that is available to guide OHCA airway management practices.

The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: A propensity score matched analysis.

While guidelines mentioned supraglottic airway management in the case of out-of- hospital cardiac arrest, robust data of their impact on the patient outcome remain scare and results are inconclusive. To assess the impact of the airway strategy on the patient outcome we prospectively enrolled 2224 individuals suffering cardiac arrest who were treated by the Viennese municipal emergency medical service. To control for potential confounders, propensity score matching was performed. Patients were matched in four groups with a 1:1:1:1 ratio ( n=210/group) according to bag-mask-valve, laryngeal tube, endotracheal intubation and secondary endotracheal intubation after primary laryngeal tube ventilation. The laryngeal tube subgroup showed the lowest 30-day survival rate among all tested devices ( p<0.001). However, in the case of endotracheal intubation after primary laryngeal tube ventilation, survival rates were comparable to the primary endotracheal tube subgroup. The use of a laryngeal tube was independently and directly associated with mortality with an adjusted odds ratio of 1.97 (confidence interval: 1.14-3.39; p=0.015). Additionally, patients receiving laryngeal tube ventilation showed the lowest rate of good neurological performance (6.7%; p<0.001) among subgroups. However, if patients received endotracheal intubation after initial laryngeal tube ventilation, the outcome proved to be significantly better (9.5%; p<0.001). We found that the use of a laryngeal tube for airway management in cardiac arrest was significantly associated with poor 30-day survival rates and unfavourable neurological outcome. A primary endotracheal airway management needs to be considered at the scene, or an earliest possible secondary endotracheal intubation during both pre-hospital and in-hospital post-return of spontaneous circulation critical care seems crucial and most beneficial for the patient outcome.

Comparing No-Flow Time During Endotracheal Intubation Versus Placement of a Laryngeal Mask Airway During a Simulated Cardiac Arrest Scenario

Traditionally, pausing chest compressions during airway management in a cardiac arrest has been the accepted norm. However, updated American Heart Association and the European Resuscitation Council guidelines for Advanced Cardiac Life Support emphasize reducing pauses in chest compressions, often referred to as "no-flow time," to improve return of spontaneous circulation. We used simulation to evaluate whether placing a laryngeal mask airway versus endotracheal intubation via direct laryngoscopy would reduce no-flow times during a simulated cardiac arrest. A crossover trial of 41 respiratory therapists (RTs) performed airway management in a simulated cardiac arrest. The RTs were told that bag mask ventilation was inadequate, and either an endotracheal tube or laryngeal mask airway was needed. They were informed to request the cessation of chest compressions only if needed to complete the airway maneuver. The study was terminated when ventilation was achieved. The scenario was repeated with the same RT placing the alternative airway. Insertion time and no-flow times were recorded. Neither endotracheal intubation via direct laryngoscopy nor laryngeal mask airway placement increased no-flow time. Only 1 participant requested cessation of chest compressions during direct laryngoscopy for 2.3 seconds (P = 0.175). However, ventilation was established significantly faster with a laryngeal mask airway compared with endotracheal intubation (49.2 vs. 31.6 seconds, respectively, P < 0.001). We conclude that although neither device was superior to the other with respect to the primary outcome of reducing no-flow time, effective ventilation was established more rapidly with the laryngeal mask airway in the hands of the RTs who participated in this study. These results may be affected by the differences between simulated and human airways.