Masashi Okubo1, Sho Komukai2, Junichi Izawa3, Koichiro Gibo4, Kosuke Kiyohara5, Tasuku Matsuyama6, Takeyuki Kiguchi7, Taku Iwami7, Clifton W Callaway8, Tetsuhisa Kitamura9. 1. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: okubom@upmc.edu. 2. Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan. 3. 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 School of Medicine, Pittsburgh, PA, USA. 4. Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, Okinawa, Japan. 5. Department of Food Science, Otsuma Women's University, Tokyo, Japan. 6. Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. 7. Health Service, Kyoto University, Kyoto, Japan. 8. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 9. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Abstract
BACKGROUND: Although prehospital advanced airway management (AAM) (i.e., endotracheal intubation [ETI] and insertion of supraglottic airways [SGA]) has been performed for paediatric out-of-hospital cardiac arrest (OHCA), the effect of AAM has not been fully studied. We evaluated the association between prehospital AAM for paediatric OHCA and patient outcomes. METHODS: We conducted an observational cohort study, using the All-Japan Utstein Registry between 2014 and 2016. We included paediatric patients (age <18 years) with OHCA. We calculated time-dependent propensity score at each minute after initiation of cardiopulmonary resuscitation by EMS providers, using a Fine-Gray regression model. We sequentially matched patients who received AAM during cardiac arrest to patients at risk of receiving AAM within the same minute (risk-set matching). The primary outcome was 1-month survival. Secondary outcome was 1-month survival with favourable functional status, defined as Cerebral Performance Category score of 1 or 2. RESULTS: We analysed 3801 paediatric patients with OHCA. 481 patients (12.7%) received AAM and 3320 (87.3%) did not. Among the 3801 analysed patients, 912 patients underwent risk-set matching. In the matched cohort, AAM was not associated with 1-month survival (AAM: 52/456 [11.4%] vs. no AAM: 44/456 [9.6%]; risk ratio [RR], 1.15 [95% CI, 0.76-1.73]; risk difference [RD], 1.5% [-3.0 to 6.1%]) or favourable functional status (AAM: 9/456 [2.0%] vs. no AAM: 10/456 [2.2%]; RR, 0.69 [95% CI, 0.26-1.79]; RD, -0.8% [-2.9 to 1.3%]). CONCLUSION: Among paediatric patients with OHCA, we found that prehospital AAM was not associated with 1-month survival or favourable functional status.
BACKGROUND: Although prehospital advanced airway management (AAM) (i.e., endotracheal intubation [ETI] and insertion of supraglottic airways [SGA]) has been performed for paediatric out-of-hospital cardiac arrest (OHCA), the effect of AAM has not been fully studied. We evaluated the association between prehospital AAM for paediatric OHCA and patient outcomes. METHODS: We conducted an observational cohort study, using the All-Japan Utstein Registry between 2014 and 2016. We included paediatric patients (age <18 years) with OHCA. We calculated time-dependent propensity score at each minute after initiation of cardiopulmonary resuscitation by EMS providers, using a Fine-Gray regression model. We sequentially matched patients who received AAM during cardiac arrest to patients at risk of receiving AAM within the same minute (risk-set matching). The primary outcome was 1-month survival. Secondary outcome was 1-month survival with favourable functional status, defined as Cerebral Performance Category score of 1 or 2. RESULTS: We analysed 3801 paediatric patients with OHCA. 481 patients (12.7%) received AAM and 3320 (87.3%) did not. Among the 3801 analysed patients, 912 patients underwent risk-set matching. In the matched cohort, AAM was not associated with 1-month survival (AAM: 52/456 [11.4%] vs. no AAM: 44/456 [9.6%]; risk ratio [RR], 1.15 [95% CI, 0.76-1.73]; risk difference [RD], 1.5% [-3.0 to 6.1%]) or favourable functional status (AAM: 9/456 [2.0%] vs. no AAM: 10/456 [2.2%]; RR, 0.69 [95% CI, 0.26-1.79]; RD, -0.8% [-2.9 to 1.3%]). CONCLUSION: Among paediatric patients with OHCA, we found that prehospital AAM was not associated with 1-month survival or favourable functional status.
Authors: Nir Samuel; Yoav Hoffmann; Stav Rakedzon; Ari M Lipsky; Aeyal Raz; Hen Ben Lulu; Hany Bahouth; Danny Epstein Journal: Eur J Trauma Emerg Surg Date: 2022-05-07 Impact factor: 3.693