Junichi Izawa1, Taku Iwami2, Koichiro Gibo3, Masashi Okubo4, Kentaro Kajino5, Kousuke Kiyohara6, Chika Nishiyama7, Tatsuya Nishiuchi8, Yasuyuki Hayashi9, Takeyuki Kiguchi2, Daisuke Kobayashi2, Sho Komukai10, Takashi Kawamura2, Clifton W Callaway4, Tetsuhisa Kitamura11. 1. Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 2. Department of Health Services, Kyoto University, Kyoto, Japan. 3. Department of Emergency Medicine, Okinawa Chubu Hospital, Okinawa, Japan. 4. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 5. Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan. 6. Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan. 7. Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan. 8. Department of Emergency and General Medicine, Amagasaki General Medical Center, Osaka, Japan. 9. Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka, Japan. 10. Clinical Research Center, Saga University Hospital, Saga, Japan. 11. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan. Electronic address: lucky_unatan@yahoo.co.jp.
Abstract
BACKGROUND: Early prehospital advanced airway management (AAM) by emergency medical services (EMS) personnel has been intended to improve patient outcomes from out-of-hospital cardiac arrest (OHCA). However, few studies examine the effectiveness of early prehospital AAM. We investigated whether early prehospital AAM was associated with functionally favourable survival after adult OHCA. METHODS: We conducted a population-based cohort study of OHCA in Osaka, Japan, between 2005 and 2012. We included all consecutive, non-traumatic adult OHCA in which EMS personnel performed cardiopulmonary resuscitation (CPR) and AAM. Main exposure was time from CPR to AAM. Primary outcome was functionally favourable survival at one-month. As the primary analysis, we estimated adjusted odds ratio (OR) of time from CPR to AAM using multivariable logistic regression in the original cohort. In the secondary analysis, we divided the time from CPR to AAM into early (0-4 min) and late (5-29 min). We calculated propensity scores (PS) for early AAM and performed PS-matching. RESULTS: We included 27,471 patients who received prehospital AAM by EMS personnel. In this original cohort, time from CPR to AAM was inversely associated with functionally favourable survival (adjusted OR 0.90 for one-increment of minute, 95% confidence interval [CI] 0.87-0.94). In the PS-matched cohort of 17,022 patients, early AAM, compared to late AAM, was associated with functionally favourable survival: 2.2% vs 1.4%; adjusted OR 1.58 (95% CI 1.24-2.02). CONCLUSIONS: Earlier prehospital AAM by EMS personnel was associated with functionally better survival among adult patients who received AAM.
BACKGROUND: Early prehospital advanced airway management (AAM) by emergency medical services (EMS) personnel has been intended to improve patient outcomes from out-of-hospital cardiac arrest (OHCA). However, few studies examine the effectiveness of early prehospital AAM. We investigated whether early prehospital AAM was associated with functionally favourable survival after adult OHCA. METHODS: We conducted a population-based cohort study of OHCA in Osaka, Japan, between 2005 and 2012. We included all consecutive, non-traumatic adult OHCA in which EMS personnel performed cardiopulmonary resuscitation (CPR) and AAM. Main exposure was time from CPR to AAM. Primary outcome was functionally favourable survival at one-month. As the primary analysis, we estimated adjusted odds ratio (OR) of time from CPR to AAM using multivariable logistic regression in the original cohort. In the secondary analysis, we divided the time from CPR to AAM into early (0-4 min) and late (5-29 min). We calculated propensity scores (PS) for early AAM and performed PS-matching. RESULTS: We included 27,471 patients who received prehospital AAM by EMS personnel. In this original cohort, time from CPR to AAM was inversely associated with functionally favourable survival (adjusted OR 0.90 for one-increment of minute, 95% confidence interval [CI] 0.87-0.94). In the PS-matched cohort of 17,022 patients, early AAM, compared to late AAM, was associated with functionally favourable survival: 2.2% vs 1.4%; adjusted OR 1.58 (95% CI 1.24-2.02). CONCLUSIONS: Earlier prehospital AAM by EMS personnel was associated with functionally better survival among adult patients who received AAM.
Authors: Liang Xi Yu; Hong Zhang; Yu Wang; Qun Zhang; Guang Bo Qu; Fang Fang; Xiao Kang Dai Journal: BMC Health Serv Res Date: 2022-04-23 Impact factor: 2.908