Prehospital Advanced Airway Use Hurts Neurologic Outcome
Findings show favorable neurologic survival down for adults with out-of-hospital cardiac arrest
TUESDAY, Jan. 15 (HealthDay News) -- For adults with out-of-hospital cardiac arrest (OHCA), the odds of favorable neurologic outcome are significantly reduced with advanced airway management versus conventional bag-valve-mask ventilation, according to a study published in the Jan. 16 issue of the Journal of the American Medical Association.
Kohei Hasegawa, M.D., M.P.H., from Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues conducted a prospective, nationwide, population-based study involving 649,654 consecutive adult patients in Japan with OHCA to examine whether prehospital advanced airway management correlates with favorable neurologic outcome one month after OHCA. Fifty-seven percent of the 649,359 eligible participants underwent bag-valve-mask ventilation, and 43 percent underwent advanced airway management, including endotracheal intubation (6 percent) and use of supraglottic airways (37 percent).
The researchers found that in the full cohort the rate of favorable neurologic outcome was significantly reduced for the advanced airway group versus the bag-valve-mask group (1.1 versus 2.9 percent; odds ratio [OR], 0.38). After adjustment for multiple variables, including age, sex, and etiology of arrest, advanced airway management was associated with significantly reduced odds of favorable neurological outcome (OR, 0.38). The odds of neurologically favorable survival were significantly reduced for management with endotracheal intubation (OR, 0.41) and supraglottic airways (OR, 0.38) in the full cohort and in a propensity score-matched cohort (adjusted OR, 0.45 and 0.36, respectively).
"Among adult patients with OHCA, any type of advanced airway management was independently associated with decreased odds of neurologically favorable survival compared with conventional bag-valve-mask ventilation," the authors write.