Joyce Yeung1, Mehboob Chilwan2, Richard Field3, Robin Davies4, Fang Gao1, Gavin D Perkins5. 1. Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom; University of Birmingham, School of Clinical and Experimental Medicine, Birmingham B15 2TT, United Kingdom. 2. Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom; University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom. 3. University of Southampton, Faculty of Medicine, SO16 6YD, United Kingdom. 4. Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom. 5. Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom; University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom. Electronic address: g.d.perkins@warwick.ac.uk.
Abstract
BACKGROUND: Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. METHODS: Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. RESULTS: One hundred patients were enrolled in the study (2008-2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8-19.4) vs. LMA median 8.0s (IQR 5.5-15.9), p=0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n=50) improved NFR from baseline median 0.24 IQR 0.17-0.40) to 0.15 to (IQR 0.09-0.28), p=0.012; LMA (n=25) from median 0.28 (IQR 0.23-0.40) to 0.13 (IQR 0.11- 0.19), p=0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n=25) (median 0.29 (IQR 0.18-0.59) vs. median 0.26 (IQR 0.12-0.37), p=0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups. CONCLUSION: The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes.
BACKGROUND: Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. METHODS: Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. RESULTS: One hundred patients were enrolled in the study (2008-2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8-19.4) vs. LMA median 8.0s (IQR 5.5-15.9), p=0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n=50) improved NFR from baseline median 0.24 IQR 0.17-0.40) to 0.15 to (IQR 0.09-0.28), p=0.012; LMA (n=25) from median 0.28 (IQR 0.23-0.40) to 0.13 (IQR 0.11- 0.19), p=0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n=25) (median 0.29 (IQR 0.18-0.59) vs. median 0.26 (IQR 0.12-0.37), p=0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups. CONCLUSION: The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes.
Authors: Lars W Andersen; Asger Granfeldt; Clifton W Callaway; Steven M Bradley; Jasmeet Soar; Jerry P Nolan; Tobias Kurth; Michael W Donnino Journal: JAMA Date: 2017-02-07 Impact factor: 56.272
Authors: Philipp Schuerner; Bastian Grande; Tobias Piegeler; Martin Schlaepfer; Leif Saager; Matthew T Hutcherson; Donat R Spahn; Kurt Ruetzler Journal: PLoS One Date: 2016-05-19 Impact factor: 3.240
Authors: Lukasz Szarpak; Agnieszka Madziala; Michael Czekajlo; Jacek Smereka; Alexander Kaserer; Marek Dabrowski; Marcin Madziala; Ruslan Yakubtsevich; Jerzy Robert Ladny; Kurt Ruetzler Journal: Medicine (Baltimore) Date: 2018-09 Impact factor: 1.817