Effect of Prehospital Advanced Airway Management on Arterial Blood Gases in the Pragmatic Airway Resuscitation Trial
Abstract Body: Background: While prehospital advanced airway devices are commonly used in out-of-hospital cardiac arrest (OHCA), whether gas exchange differs between devices is unknown. Objective: To characterize arterial blood gas (ABG) differences between patients receiving laryngeal tube (LT) or endotracheal intubation (ETI) in the Pragmatic Airway Resuscitation Trial (PART). Methods: We included adult OHCA enrolled in PART with first ABG collected ≤ 90 minutes after emergency department (ED) arrival. We identified 1) last prehospital airway technique used (LT vs. ETI), 2) average end-tidal capnography (EtCO2) values for the last 5 minutes of prehospital care, 3) return of spontaneous circulation (ROSC) in the ED, and 4) ED ABG measurements (pH, PaO2, PaCO2). We compared ABG values between LT and ETI using the Mann-Whitney test, stratifying by ROSC vs. non-ROSC. We also determined the correlation between last 5-minute mean prehospital EtCO2 and PaCO2 using Pearson’s correlation. We also compared absolute difference between EtCO2 and PaCO2 (PaCO2 - EtCO2) using the Mann-Whitney test. All blood gas and EtCO2 values are reported in mmHg. Results: Of 3004 patients enrolled in the parent trial, 483 had an ABG ≤ 90 minutes after ED arrival; 276 LT, 129 ETI, 76 no advanced airway, and 2 unknown. Among patients with ROSC in the ED, pH did not differ between LT and ETI (7.1 vs. 7.2, p=0.10), PaO2 showed a tendency toward lower values in LT than ETI (142 vs. 170, p=0.07), and PaCO2 was significantly higher in LT compared to ETI (59 vs. 50, p=0.002). Among patients without ROSC, pH did not differ between LT and ETI (7.0 vs. 7.0, p=0.55), PaO2 was significantly lower in LT than ETI (85 vs. 123, p=0.03), and PaCO2 did not differ between LT and ETI (64 vs. 60.5, p=0.58). EtCO2 did not correlate with PaCO2 in any airway device/ROSC combination: [LT+ROSC] r=0.02, [ETI+ROSC] r=0.14, [LT+non-ROSC] r=-0.11, [ETI+non-ROSC] r=0.51. PaCO2 - EtCO2 was significantly wider in non-ROSC than ROSC cases (27 vs. 18, p=0.03) but did not differ by airway device. Conclusions: ABG values may vary by prehospital advanced airway management methods. The correlation between EtCO2 and PaCO2 in patients with OHCA remains unclear.
Sullivan, Grace
( The Ohio State University
, Columbus
, Ohio
, United States
)
Stephens, Shannon
( University of Alabama at Birmingham
, Birmingham
, Alabama
, United States
)
Carlson, Jestin
( US Acute Care Solutions
, Canton
, Ohio
, United States
)
Nichol, Graham
( University of Washington
, Seattle
, Washington
, United States
)
Aufderheide, Tom
( Medical College of Wisconsin
, Milwaukee
, Wisconsin
, United States
)
Panchal, Ashish
( The Ohio State University
, Columbus
, Ohio
, United States
)
Nassal, Michelle
( The Ohio State University
, Columbus
, Ohio
, United States
)
Wang, Henry
( The Ohio State University
, Columbus
, Ohio
, United States
)
Gage, Christopher
( National Registry of EMTs
, Columbus
, Ohio
, United States
)
Powell, Jonathan
( National Registry of EMTs
, Columbus
, Ohio
, United States
)
Aramendi, Elisabete
( UNIVERSITY OF THE BASQUE COUNTRY
, Bilbao
, Spain
)
Jaureguibeitia, Xabier
( University of the Basque Country
, Bilbao
, Spain
)
Elola, Andoni
( University of the Basque Country
, Bilbao
, Spain
)
Idris, Ahamed
( UT Southwestern
, Dallas
, Texas
, United States
)
Daya, Mohamud
( OHSU
, Portland
, Oregon
, United States
)
Author Disclosures:
Grace Sullivan:DO NOT have relevant financial relationships
| Shannon Stephens:DO have relevant financial relationships
;
Consultant:CSL Behring:Past (completed)
; Research Funding (PI or named investigator):DOD:Active (exists now)
; Research Funding (PI or named investigator):CSL Behring:Active (exists now)
; Research Funding (PI or named investigator):NIH/NHLBI:Active (exists now)
; Independent Contractor:Commission on Accreditation of Ambulance Services:Active (exists now)
; Consultant:Infrascan:Active (exists now)
; Consultant:CeleCor Therapeutics:Past (completed)
| Jestin Carlson:No Answer
| Graham Nichol:No Answer
| Tom Aufderheide:DO have relevant financial relationships
;
Researcher:NINDS:Active (exists now)
; Consultant:Medtronic:Past (completed)
; Researcher:AstraZeneca:Active (exists now)
; Researcher:MeMed:Active (exists now)
; Researcher:Abbott:Active (exists now)
; Researcher:Cytovale:Active (exists now)
; Researcher:ZOLL:Active (exists now)
; Researcher:Inflammatix, Inc.:Active (exists now)
; Researcher:NHLBI:Active (exists now)
| Ashish Panchal:DO NOT have relevant financial relationships
| Michelle Nassal:No Answer
| Henry Wang:DO NOT have relevant financial relationships
| Christopher Gage:DO NOT have relevant financial relationships
| Jonathan Powell:DO NOT have relevant financial relationships
| ELISABETE ARAMENDI:DO NOT have relevant financial relationships
| Xabier Jaureguibeitia:No Answer
| Andoni Elola:No Answer
| Ahamed Idris:No Answer
| Mohamud Daya:DO NOT have relevant financial relationships
