Abstract Body: After the implemetation of special emergency services, advanced airway management(AAM) in cardiac arrest has been tried actively. We aim to compare the success rates and patient outcomes of supraglottic airway(SGA), endotracheal intubation with direct laryngoscope(ETI with DL), and endotracheal intubation with video laryngoscope(ETI with VL) in patients with sudden cardiac arrest, and evaluate the effectiveness of the video laryngoscope in the pre-hospital stage.
This study was conducted on cardiac arrest patients who transferred to ED by EMS from July 2019 to December 2021. Using the Korean OHCA registry, EMS ambulance runsheet, and cardiac arrest in-depth registry, patients with sudden cardiac arrest over 18 years old, caused by medical cause, and who were treated by the special EMS team at the site and got AAM were enrolled. Cases with unknown information on AAM success or time of arrival/death were excluded. Pre-hospital ROSC, 72 hr survival, survival to discharge, good neurological outcome were compared among SGA, ETI with DL and ETI with VL using multivariable logistic regression. Initial AAM success and final success rates were also compared.
10,587 cases were enrolled in the study, of which 9379 cases got SGA, 493 ETI with DL, and 985 ETI with VL. In the first attempt, the insertion success rate is higher with SGA, but the overall success is higher with VL. For any prehospital ROSC, compared to SGA, ETI with DL was 1.33 (1.00-1.75), and ETI with VL was 1.92 (1.57-2.34). Compared to SGA, aOR for survival within 72 hours was 1.13 (0.81-1.56), 1.34 (1.06-1.70), survival to discharge was 1.05 (0.64-1.65), 1.06 (0.74-1.49), and good neurological outcome was 0.64 (0.31-1.25), 1.17(0.71-1.86) in ETI with DL or ETI with VL respectively. Compared to the SGA, aOR of the initial success was 0.44 (0.32-0.61) and 0.48 (0.38-0.62) in the ETI with DL and ETI with VL groups, respectively, and the final success rate was 0.78 (0.45-1.44), 1.14 (0.72-1.94).
Endotracheal intubation in EMS showed the lower initial success rate than SGA, but when using a video-laryngoscope, the final success rate rises to a sufficiently similar level, and the pre-hospital ROSC success rate is higher than that of SGA.