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Katabami K, Kimura T, Hirata T, Tamakoshi A. Association Between Advanced Airway Management With Adrenaline Injection and Prognosis in Adult Patients With Asystole Asphyxia Out-of-hospital Cardiac Arrest. J Epidemiol 2024; 34:31-37. [PMID: 36709978 PMCID: PMC10701249 DOI: 10.2188/jea.je20220240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/26/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The neurological prognosis of asphyxia is poor and the effect of advanced airway management (AAM) in the prehospital setting remains unclear. This study aimed to evaluate the association between AAM with adrenaline injection and prognosis in adult patients with asystole asphyxia out-of-hospital cardiac arrest (OHCA). METHODS This study assessed all-Japan Utstein cohort registry data between January 1, 2013 and December 31, 2019. We used propensity score matching analyses before logistic regression analysis to evaluate the effect of AAM on favorable neurological outcome. RESULTS There were 879,057 OHCA cases, including 70,299 cases of asphyxia OHCAs. We extracted the data of 13,642 cases provided with adrenaline injection by emergency medical service. We divided 7,945 asphyxia OHCA cases in asystole into 5,592 and 2,353 with and without AAM, respectively. After 1:1 propensity score matching, 2,338 asphyxia OHCA cases with AAM were matched with 2,338 cases without AAM. Favorable neurological outcome was not significantly different between the AAM and no AAM groups (adjusted odds ratio [OR] 1.1; 95% confidence interval [CI], 0.5-2.5). However, the return of spontaneous circulation (ROSC) (adjusted OR 1.7; 95% CI, 1.5-1.9) and 1-month survival (adjusted OR 1.5; 95% CI, 1.1-1.9) were improved in the AAM group. CONCLUSION AAM with adrenaline injection for patients with asphyxia OHCA in asystole was associated with improved ROSC and 1-month survival rate but showed no differences in neurologically favorable outcome. Further prospective studies may comprehensively evaluate the effect of AAM for patients with asphyxia.
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Affiliation(s)
- Kenichi Katabami
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Jarvis JL, Panchal AR, Lyng JW, Bosson N, Donofrio-Odmann JJ, Braude DA, Browne LR, Arinder M, Bolleter S, Gross T, Levy M, Lindbeck G, Maloney LM, Mattera CJ, Wang CT, Crowe RP, Gage CB, Lang ES, Sholl JM. Evidence-Based Guideline for Prehospital Airway Management. PREHOSP EMERG CARE 2023; 28:545-557. [PMID: 38133523 DOI: 10.1080/10903127.2023.2281363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023]
Abstract
Airway management is a cornerstone of emergency medical care. This project aimed to create evidence-based guidelines based on the systematic review recently conducted by the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel was assembled to review the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The panel made specific recommendations on the different PICO (population, intervention, comparison, outcome) questions reviewed in the AHRQ review and created good practice statements that summarize and operationalize these recommendations. The recommendations address the use of ventilation with bag-valve mask ventilation alone vs. supraglottic airways vs. endotracheal intubation for adults and children with cardiac arrest, medical emergencies, and trauma. Additional recommendations address the use of video laryngoscopy and drug-assisted airway management. These recommendations, and the associated good practice statements, offer EMS agencies and clinicians an opportunity to review the available evidence and incorporate it into their airway management strategies.
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Affiliation(s)
- Jeffrey L Jarvis
- Office of the Medical Director, Metropolitan Area EMS Authority, Fort Worth, Texas
| | - Ashish R Panchal
- National Registry of Emergency Medical Technicians, Columbus, Ohio
| | - John W Lyng
- Emergency Medicine, North Memorial Health Hospital Level 1 trauma center, Minneapolis, Minnesota
| | - Nichole Bosson
- EMS, Los Angeles County Department of Health Services, Los Angeles, California
| | | | - Darren A Braude
- Department of Emergency Medicine, The University of New Mexico, Albuquerque, New Mexico
| | - Lorin R Browne
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Arinder
- EMS, Global Medical Response Inc., Greenwood Village, Colorado
| | - Scott Bolleter
- EMS, Healthcare Innovation & Sciences Centre, Spring Branch, Texas
| | - Toni Gross
- Department of Emergency Medicine, LCMC Health, New Orleans, Louisiana
| | | | - George Lindbeck
- National Registry of Emergency Medical Technicians, Columbus, Ohio
| | - Lauren M Maloney
- Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, New York
| | | | - Cheng-Teng Wang
- Department of Emergency Medicine, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | | | - Christopher B Gage
- Research, National Registry of Emergency Medical Technicians, Columbus, Ohio
| | - Eddy S Lang
- Department of Emergency Medicine, Alberta Health Services, Edmonton, Canada
| | - J Matthew Sholl
- National Registry of Emergency Medical Technicians, Columbus, Ohio
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Htet NN, Jafari D, Walker JA, Pourmand A, Shaw A, Dinh K, Tran QK. Trend of Outcome Metrics in Recent Out-of-Hospital-Cardiac-Arrest Research: A Narrative Review of Clinical Trials. J Clin Med 2023; 12:7196. [PMID: 38002808 PMCID: PMC10672249 DOI: 10.3390/jcm12227196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Cardiopulmonary resuscitation (CPR) research traditionally focuses on survival. In 2018, the International Liaison Committee on Resuscitation (ILCOR) proposed more patient-centered outcomes. Our narrative review assessed clinical trials after 2018 to identify the trends of outcome metrics in the field OHCA research. We performed a search of the PubMed database from 1 January 2019 to 22 September 2023. Prospective clinical trials involving adult humans were eligible. Studies that did not report any patient-related outcomes or were not available in full-text or English language were excluded. The articles were assessed for demographic information and primary and secondary outcomes. We included 89 studies for analysis. For the primary outcome, 31 (35%) studies assessed neurocognitive functions, and 27 (30%) used survival. For secondary outcomes, neurocognitive function was present in 20 (22%) studies, and survival was present in 10 (11%) studies. Twenty-six (29%) studies used both survival and neurocognitive function. Since the publication of the COSCA guidelines in 2018, there has been an increased focus on neurologic outcomes. Although survival outcomes are used frequently, we observed a trend toward fewer studies with ROSC as a primary outcome. There were no quality-of-life assessments, suggesting a need for more studies with patient-centered outcomes that can inform the guidelines for cardiac-arrest management.
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Affiliation(s)
- Natalie N. Htet
- Department of Emergency Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Daniel Jafari
- Donald and Barbara Zucker School of Medicine Hofstra Northwell, Hempstead, NY 11549, USA;
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
| | - Jennifer A. Walker
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX 76104, USA;
- Department of Emergency Medicine, Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA;
| | - Anna Shaw
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Khai Dinh
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Quincy K. Tran
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Ding B, Xu F, Wang J, Pan C, Pang J, Chen Y, Li K. Design and evaluation of portable emergency ventilator prototype with novel titration methods. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Kwong JL, Drennan IR, Turner L, Cheskes S. Predefibrillation end-tidal CO 2 and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study. J Accid Emerg Med 2023; 40:48-55. [PMID: 36171074 DOI: 10.1136/emermed-2021-211951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/07/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Predefibrillation end-tidal CO2 (ETCO2) may predict defibrillation success and could guide defibrillation timing in ventricular fibrillation (VF) cardiac arrest. This relationship has only been studied using advanced airways. Our aim was to evaluate this relationship using both basic (bag-valve-mask (BVM)) and advanced airways (supraglottic airways and endotracheal tubes). METHODS Prehospital patient records and defibrillator files were abstracted for patients with out-of-hospital cardiac arrest in Ontario, Canada, with initial VF cardiac rhythms between 1 January 2018, and 31 December 2019. Analyses assessed the relationship between each predefibrillation ETCO2 reading and defibrillation outcomes at the subsequent 2 min pulse check (ie, VF, asystole, pulseless electrical activity (PEA) or return of spontaneous circulation (ROSC)), accounting for airway types used during resuscitation. Multivariable logistic regression evaluated the association between the first documented predefibrillation ETCO2 and postshock VF termination or ROSC. RESULTS Of 269 cases abstracted, 153 had predefibrillation ETCO2 measurements and were included in the study. Among these cases, 904 shocks were delivered and 44.4% (n=401) had predefibrillation ETCO2 measured. The first ETCO2 reading was more often from BVM (n=134) than advanced airways (n=19). ETCO2 readings were lower when measured through BVM versus advanced airways (30.5 mm Hg (4.06 kPa) (±14.4 mm Hg (1.92 kPa)) vs 42.1 mm Hg (5.61 kPa) (±22.5 mm Hg (3.00 kPa)), adjANOVA p<0.01). Of all shocks with ETCO2 reading (n=401), no difference in preshock ETCO2 was found for subsequent shocks that resulted in persistent VF (32.2 mm Hg (4.29 kPa) (±15.8 mm Hg (2.11 kPa))), PEA (32.8 mm Hg (4.37 kPa) (±17.1 mm Hg (2.30 kPa))), asystole (32.4 mm Hg (4.32 kPa) (±20.6 mm Hg (2.75 kPa))) or ROSC (32.5 mm Hg (4.33 kPa) (±15.3 mm Hg (2.04 kPa))), analysis of variance p=0.99. In the multivariate analysis using the initial predefibrillation ETCO2, there was no association with VF termination on the subsequent shock (adjusted OR (adjOR) 0.99, 95% CI 0.97 to 1.02, p=0.57) or ROSC (adjOR 1.00, 95% CI 0.97 to 1.03, p=0.94) when evaluated as a continuous or categorical variable. CONCLUSION Predefibrillation ETCO2 measurement is not associated with VF termination or ROSC when basic and advanced airways are included in the analysis. The role of predefibrillation ETCO2 requires careful consideration of the type of airway used during resuscitation.
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Affiliation(s)
- Jonathan L Kwong
- Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ian R Drennan
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Linda Turner
- Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada
| | - Sheldon Cheskes
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada
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Carney N, Totten AM, Cheney T, Jungbauer R, Neth MR, Weeks C, Davis-O'Reilly C, Fu R, Yu Y, Chou R, Daya M. Prehospital Airway Management: A Systematic Review. PREHOSP EMERG CARE 2022; 26:716-727. [PMID: 34115570 DOI: 10.1080/10903127.2021.1940400] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Objective: To assess comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) used by prehospital emergency medical services (EMS) to treat patients with trauma, cardiac arrest, or medical emergencies, and how they differ based on techniques and devices, EMS personnel and patient characteristics. Data sources: We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020. Review methods: We followed Agency for Healthcare Research and Quality Effective Health Care Program Methods guidance. Outcomes included mortality, neurological function, return of spontaneous circulation (ROSC), and successful advanced airway insertion. Meta-analyses using profile-likelihood random effects models were conducted, with analyses stratified by study design, emergency type, and age. Results: We included 99 studies involving 630,397 patients. We found few differences in primary outcomes across airway management approaches. For survival, there was no difference for BVM versus ETI or SGA in adult and pediatric patients with cardiac arrest or trauma. For neurological function, there was no difference for BVM versus ETI and SGA versus ETI in pediatric patients with cardiac arrest. There was no difference in BVM versus ETI in adults with cardiac arrest, but improved neurological function with BVM or ETI versus SGA. There was no difference in ROSC for patients with cardiac arrest for BVM versus ETI or SGA in adults and pediatrics, or SGA versus ETI in pediatrics. There was higher frequency of ROSC in adults with SGA versus ETI. For successful advanced airway insertion, there was higher first-pass success with SGA versus ETI for all patients except adult medical patients (no difference), and no difference in overall success using SGA versus ETI in adults. Conclusions: The currently available evidence does not indicate benefits of more invasive airway approaches based on survival, neurological function, ROSC, or successful airway insertion. Strength of evidence was low or moderate; most included studies were observational. This supports the need for high-quality randomized controlled trials to advance clinical practice and EMS education and policy, and improve patient-centered outcomes.
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Medication-Facilitated Advanced Airway Management with First-Line Use of a Supraglottic Device - A One-Year Quality Assurance Review. Prehosp Disaster Med 2022; 37:561-565. [PMID: 35587719 PMCID: PMC9280059 DOI: 10.1017/s1049023x22000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Airway management is a controversial topic in modern Emergency Medical Services (EMS) systems. Among many concerns regarding endotracheal intubation (ETI), unrecognized esophageal intubation and observations of unfavorable neurologic outcomes in some studies raise the question of whether alternative airway techniques should be first-line in EMS airway management protocols. Supraglottic airway devices (SADs) are simpler to use, provide reliable oxygenation and ventilation, and may thus be an alternative first-line airway device for paramedics. In 2019, Alachua County Fire Rescue (ACFR; Alachua, Florida USA) introduced a novel protocol for advanced airway management emphasizing first-line use of a second-generation SAD (i-gel) for patients requiring medication-facilitated airway management (referred to as "rapid sequence airway" [RSA] protocol). STUDY OBJECTIVE This was a one-year quality assurance review of care provided under the RSA protocol looking at compliance and first-pass success rate of first-line SAD use. METHODS Records were obtained from the agency's electronic medical record (EMR), searching for the use of the RSA protocol, advanced airway devices, or either ketamine or rocuronium. If available, hospital follow-up data regarding patient condition and emergency department (ED) airway exchange were obtained. RESULTS During the first year, 33 advanced airway attempts were made under the protocol by 23 paramedics. Overall, compliance with the airway device sequence as specified in the protocol was 72.7%. When ETI was non-compliantly used as first-line airway device, the first-pass success rate was 44.4% compared to 87.5% with adherence to first-line SAD use. All prehospital SADs were exchanged in the ED in a delayed fashion and almost exclusively per physician preference alone. In no case was the SAD exchanged for suspected dislodgement evidenced by lack of capnography. CONCLUSION First-line use of a SAD was associated with a high first-pass attempt success rate in a real-life cohort of prehospital advanced airway encounters. No SAD required emergent exchange upon hospital arrival.
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Chang H, Jeong D, Park JE, Kim T, Lee GT, Yoon H, Hwang SY, Cha WC, Shin TG, Sim MS, Jo IJ, Lee S, Shin SD, Choi J. Prehospital airway management for out-of-hospital cardiac arrest: A nationwide multicenter study from the KoCARC registry. Acad Emerg Med 2022; 29:581-588. [PMID: 35064725 DOI: 10.1111/acem.14443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 01/01/2023]
Abstract
AIM This study investigated whether prehospital advanced airway management (AAM) is associated with improved survival of out-of-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask (BVM) ventilation. METHODS We investigated the neurologically favorable survival of adult patients with OHCA who underwent BVM or AAM using the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA registry of Korea. The differences in clinical characteristics were adjusted by matching or weighting the clinical propensity for use of AAM or by least absolute shrinkage and selection operator (LASSO). The primary outcome was 30-day survival with neurologically favorable status defined by cerebral performance category 1 or 2. RESULTS Of the 9,616 patients enrolled (median age = 71 years; 65% male), there were 6,243 AAM and 3,354 BVM patients. In unadjusted analysis, the 30-day neurologically favorable survival was lower in the AAM group compared with the BVM group (5.5% vs. 10.0%; hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 1.16 to 1.27; all p < 0.001). In propensity score matching-adjusted analysis, these differences were not found (9.6% vs. 10.0%; HR = 0.98, 95% CI = 0.93 to 1.03, p > 0.05). Inverse probability of treatment weighting- and LASSO-adjusted analyses replicated these results. CONCLUSIONS In this nationwide real-world data analysis of OHCA, the 30-day neurologically favorable survival did not differ between prehospital AAM and BVM after adjustment for clinical characteristics.
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Affiliation(s)
- Hansol Chang
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Digital Health SAIHST, Sungkyunkwan University Seoul South Korea
| | - Daun Jeong
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Digital Health SAIHST, Sungkyunkwan University Seoul South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Seung‐Hwa Lee
- Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine College of Medicine, Seoul National University Seoul Republic of Korea
| | - Jin‐Ho Choi
- Department of Emergency Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
- Department of Digital Health SAIHST, Sungkyunkwan University Seoul South Korea
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Tang Y, Sun M, Zhu A. Outcome of cardiopulmonary resuscitation with different ventilation modes in adults: A meta-analysis. Am J Emerg Med 2022; 57:60-69. [DOI: 10.1016/j.ajem.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022] Open
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Airway Management During Cardiopulmonary Resuscitation. CURRENT ANESTHESIOLOGY REPORTS 2022; 12:363-372. [PMID: 35370477 PMCID: PMC8951653 DOI: 10.1007/s40140-022-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
Purpose of the review Recent Findings Summary
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Carlson JN, Colella MR, Daya MR, J De Maio V, Nawrocki P, Nikolla DA, Bosson N. Prehospital Cardiac Arrest Airway Management: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:54-63. [PMID: 35001831 DOI: 10.1080/10903127.2021.1971349] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. Multiple cardiac arrest airway management techniques are available to EMS clinicians including bag-valve-mask (BVM) ventilation, supraglottic airways (SGAs), and endotracheal intubation (ETI). Important goals include achieving optimal oxygenation and ventilation while minimizing negative effects on physiology and interference with other resuscitation interventions. NAEMSP recommends:Based on the skill of the clinician and available resources, BVM, SGA, or ETI may be considered as airway management strategies in OHCA.Airway management should not interfere with other key resuscitation interventions such as high-quality chest compressions, rapid defibrillation, and treatment of reversible causes of the cardiac arrest.EMS clinicians should take measures to avoid hyperventilation during cardiac arrest resuscitation.Where available for clinician use, capnography should be used to guide ventilation and chest compressions, confirm and monitor advanced airway placement, identify return of spontaneous circulation (ROSC), and assist in the decision to terminate resuscitation.
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Groulx M, Emond M, Boudreau-Drouin F, Cournoyer A, Nadeau A, Blanchard PG, Mercier E. Continuous flow insufflation of oxygen for cardiac arrest: Systematic review of human and animal model studies. Resuscitation 2021; 162:292-303. [PMID: 33766663 DOI: 10.1016/j.resuscitation.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To synthetize the evidence regarding the effect of constant flow insufflation of oxygen (CFIO) on the rate of return of spontaneous circulation (ROSC) and other clinical outcomes during cardiac arrest (CA). METHODS A systematic review was performed using four databases (PROSPERO: CRD42020071960). Studies reporting on adult CA patients or on animal models simulating CA and assessing the effect of CFIO on ROSC or other clinical outcomes were considered. RESULTS A total of 3540 citations were identified, of which 16 studies were included. Four studies (two randomized controlled trials (RCT), two cohort studies), reported on humans while 12 studies used animal models. No meta-analysis was performed due to clinical heterogeneity. There were no differences in the ROSC (18.9% vs 20.8%, p = 0.99; 27.1% vs 21.3%, p = 0.51) and sustained ROSC rates (16.1% vs 17.3%, p = 0.81; 12.5% vs 14.9%, p = 0.73) with CFIO compared to intermitant positive pressure ventilation (IPPV) in the two human RCTs. Survival to ICU discharge was similar between CFIO (2.3%) and IPPV (2.3%) in the largest RCT (p = 0.96). Human studies were at serious or high risk of bias. In animal models' studies, ROSC rates were presented in seven RCTs. CFIO was superior to IPPV in one trial, but was associated with similar ROSC rates using different ventilation strategies in the remaining six studies. CONCLUSIONS No definitive association between CFIO and ROSC, sustained ROSC or survival compared to other ventilation strategies could be demonstrated. Future studies should assess CFIO effect on post-survival neurological functions and patient-important CA outcomes.
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Affiliation(s)
- Mathieu Groulx
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Marcel Emond
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Felix Boudreau-Drouin
- Faculté de Médecine, Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Alexis Cournoyer
- Faculté de médecine, Université de Montréal, Québec, Canada; Département de médecine d'urgence, Hôpital du Sacré-Cœur, Montréal, Québec, Canada; Département de médecine d'urgence, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Alexandra Nadeau
- VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Pierre-Gilles Blanchard
- Faculté de Médecine, Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada
| | - Eric Mercier
- Faculté de Médecine, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada.
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van Schuppen H, Boomars R, Kooij FO, den Tex P, Koster RW, Hollmann MW. Optimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review. Best Pract Res Clin Anaesthesiol 2020; 35:67-82. [PMID: 33742579 DOI: 10.1016/j.bpa.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. Endotracheal intubation can still be indicated, but has the largest downsides of all advanced airway techniques. Whichever stage of airway management, ventilation and chest compression quality should be closely monitored. Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.
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Affiliation(s)
- Hans van Schuppen
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - René Boomars
- Regional Ambulance Service Utrecht (RAVU), Jan van Eijcklaan 6, Bilthoven, the Netherlands
| | - Fabian O Kooij
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Helicopter Mobile Medical Team (MMT), De Boelelaan 1117, Amsterdam, the Netherlands
| | - Paul den Tex
- University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Amsterdam Resuscitation Studies (ARREST), Meibergdreef 9, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands
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14
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Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial. J Clin Med 2020; 9:jcm9072045. [PMID: 32610672 PMCID: PMC7408746 DOI: 10.3390/jcm9072045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 01/16/2023] Open
Abstract
The role of advanced airway management (AAM) in cardiopulmonary resuscitation (CPR) is currently debated as observational studies reported better outcomes after bag-mask ventilation (BMV), and the only prospective randomized trial was inconclusive. Adherence to CPR guidelines ventilation recommendations is unknown and difficult to assess in clinical trials. This study compared AAM and BMV with regard to adherence to ventilation recommendations and chest compression fractions in simulated cardiac arrests. A total of 154 teams of 3–4 physicians were randomized to perform CPR with resuscitation equipment restricting airway management to BMV only or equipment allowing for all forms of AAM. BMV teams ventilated 6 ± 6/min and AAM teams 19 ± 8/min (range 3–42/min; p < 0.0001 vs. BMV). 68/78 BMV teams and 23/71 AAM teams adhered to the ventilation recommendations (p < 0.0001). BMV teams had lower compression fractions than AAM teams (78 ± 7% vs. 86 ± 6%, p < 0.0001) resulting entirely from higher no-flow times for ventilation (9 ± 4% vs. 3 ± 3 %; p < 0.0001). Compared to BMV, AAM leads to significant hyperventilation and lower adherence to ventilation recommendations but favourable compression fractions. The cumulative effect of deviations from ventilation recommendations has the potential to blur findings in clinical trials.
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15
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McMullan JT, Braude DA. Poison, Pixie Dust, and Prehospital Airway Management. Acad Emerg Med 2020; 27:431-433. [PMID: 32220122 DOI: 10.1111/acem.13926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jason T. McMullan
- Department of Emergency Medicine University of Cincinnati Cincinnati OH
- Departments of Emergency Medicine and Anesthesiology University of New Mexico Health Sciences Center Albuquerque NM
| | - Darren A. Braude
- Department of Emergency Medicine University of Cincinnati Cincinnati OH
- Departments of Emergency Medicine and Anesthesiology University of New Mexico Health Sciences Center Albuquerque NM
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