Sarah Montag1, Steffen Herdtle2, Samuel John3, Thomas Lehmann4, Wilhelm Behringer5, Christian Hohenstein6. 1. Klinik für Anaesthesiologie, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany. sarah.montag@med.lmu.de. 2. Akut- und Notfallmedizin, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734, Hausham, Germany. 3. Klinik für Anästhesie und Intensivmedizin, ISAR Klinikum, Sonnenstr. 24-26, 80331, Munich, Germany. 4. Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Germany. 5. Universitätsklinik für Notfallmedizin, MedUni Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria. 6. Interdisziplinäres Notfallzentrum, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437, Bad Berka, Germany.
Abstract
BACKGROUND: Advanced airway management (AAM) is part of the standard treatment during advanced cardiac life support (ACLS). Current studies underline the importance of a first-pass intubation success (FPS) during in-hospital ACLS. It was shown that a failed initial intubation attempt in out-of-hospital cardiac arrest (OHCA) patients in the emergency department is an independent risk factor for the decreased effectiveness of ACLS measured by the return of spontaneous circulation (ROSC). OBJECTIVE: This study first examines the association between prehospital FPS and ROSC in adults with OHCA and second identifies factors associated with FPS and ROSC. The initial hypothesis was that FPS would increase the probability of ROSC as well as decrease the time to ROSC. MATERIAL AND METHODS: A retrospective multicenter analysis of 180 adult non-traumatic OHCA patients on whom advanced airway management (AAM) was performed between July 2017 and December 2018 in five different German physician-staffed ambulance stations. For information on FPS the Intubation Registry, and for information on ROSC the German Resuscitation Registry were used. In addition to yes/no questions, multiple answers and free text answers are possible in those questionnaires. The main outcome variables were 'FPS', 'ROSC' and 'time to ROSC'. Mann-Whitney tests, χ2-tests, Fisher's exact tests and multivariate binary logistic regressions were used for the statistical evaluation. Demographic factors, characteristics of the performer, selected equipment, laryngoscopy type, intubation method, medications, verification of tube position, respiratory evaluation, complications and time to ROSC were examined with respect to the influence on FPS. Concerning ROSC, the following factors were examined: demographic factors, initial heart rhythm, initial breathing, medications, defibrillation and AAM. RESULTS: An FPS was recorded in 150 patients (83.3%), and ROSC was achieved in 82 patients (45.5%) after an average time of 22.16 min. There was a positive association between FPS and ROSC (p = 0.027). In patients with FPS, a trend for shorter time to ROSC was observed (p = 0.059; FPS 18 min; no FPS 28 min). The use of capnography (odds ratio, OR = 7.384, 95% confidence interval, CI 1.886-28.917) and complications during AAM (OR = 0.033, 95% CI: 0.007-0.153) were independently associated with FPS. The independent factor associated with ROSC was FPS (OR = 5.281, 95% CI: 1.800-15.494). CONCLUSION: In prehospitally resuscitated adult OHCA patients with AAM, FPS is associated with a higher chance of ROSC.
BACKGROUND: Advanced airway management (AAM) is part of the standard treatment during advanced cardiac life support (ACLS). Current studies underline the importance of a first-pass intubation success (FPS) during in-hospital ACLS. It was shown that a failed initial intubation attempt in out-of-hospital cardiac arrest (OHCA) patients in the emergency department is an independent risk factor for the decreased effectiveness of ACLS measured by the return of spontaneous circulation (ROSC). OBJECTIVE: This study first examines the association between prehospital FPS and ROSC in adults with OHCA and second identifies factors associated with FPS and ROSC. The initial hypothesis was that FPS would increase the probability of ROSC as well as decrease the time to ROSC. MATERIAL AND METHODS: A retrospective multicenter analysis of 180 adult non-traumatic OHCA patients on whom advanced airway management (AAM) was performed between July 2017 and December 2018 in five different German physician-staffed ambulance stations. For information on FPS the Intubation Registry, and for information on ROSC the German Resuscitation Registry were used. In addition to yes/no questions, multiple answers and free text answers are possible in those questionnaires. The main outcome variables were 'FPS', 'ROSC' and 'time to ROSC'. Mann-Whitney tests, χ2-tests, Fisher's exact tests and multivariate binary logistic regressions were used for the statistical evaluation. Demographic factors, characteristics of the performer, selected equipment, laryngoscopy type, intubation method, medications, verification of tube position, respiratory evaluation, complications and time to ROSC were examined with respect to the influence on FPS. Concerning ROSC, the following factors were examined: demographic factors, initial heart rhythm, initial breathing, medications, defibrillation and AAM. RESULTS: An FPS was recorded in 150 patients (83.3%), and ROSC was achieved in 82 patients (45.5%) after an average time of 22.16 min. There was a positive association between FPS and ROSC (p = 0.027). In patients with FPS, a trend for shorter time to ROSC was observed (p = 0.059; FPS 18 min; no FPS 28 min). The use of capnography (odds ratio, OR = 7.384, 95% confidence interval, CI 1.886-28.917) and complications during AAM (OR = 0.033, 95% CI: 0.007-0.153) were independently associated with FPS. The independent factor associated with ROSC was FPS (OR = 5.281, 95% CI: 1.800-15.494). CONCLUSION: In prehospitally resuscitated adult OHCA patients with AAM, FPS is associated with a higher chance of ROSC.
Authors: Jasmeet Soar; Jerry P Nolan; Bernd W Böttiger; Gavin D Perkins; Carsten Lott; Pierre Carli; Tommaso Pellis; Claudio Sandroni; Markus B Skrifvars; Gary B Smith; Kjetil Sunde; Charles D Deakin Journal: Resuscitation Date: 2015-10 Impact factor: 5.262
Authors: Koenraad G Monsieurs; Jerry P Nolan; Leo L Bossaert; Robert Greif; Ian K Maconochie; Nikolaos I Nikolaou; Gavin D Perkins; Jasmeet Soar; Anatolij Truhlář; Jonathan Wyllie; David A Zideman Journal: Resuscitation Date: 2015-10-15 Impact factor: 5.262
Authors: Benjamin A White; Marjory A Bravard; Kimiyoshi J Kobayashi; Joshua C Ziperstein; Joan L Strauss; Maryfran Hughes; Ali S Raja Journal: Am J Emerg Med Date: 2018-11-06 Impact factor: 2.469
Authors: Jan-Thorsten Gräsner; Jan Wnent; Johan Herlitz; Gavin D Perkins; Rolf Lefering; Ingvild Tjelmeland; Rudolph W Koster; Siobhán Masterson; Fernando Rossell-Ortiz; Holger Maurer; Bernd W Böttiger; Maximilian Moertl; Pierre Mols; Hajriz Alihodžić; Irzal Hadžibegović; Marios Ioannides; Anatolij Truhlář; Mads Wissenberg; Ari Salo; Josephine Escutnaire; Nikolaos Nikolaou; Eniko Nagy; Bergthor Steinn Jonsson; Peter Wright; Federico Semeraro; Carlo Clarens; Steffie Beesems; Grzegorz Cebula; Vitor H Correia; Diana Cimpoesu; Violetta Raffay; Stefan Trenkler; Andrej Markota; Anneli Strömsöe; Roman Burkart; Scott Booth; Leo Bossaert Journal: Resuscitation Date: 2020-02-03 Impact factor: 5.262