Guest guest Posted June 15, 2012 Report Share Posted June 15, 2012 It has been a while since I stirred the pot. I'm worried about my skills becoming rusty . . . so here it is . . . A abstract from a paper just accepted for publication OBJECTIVE: To simplify airway management and minimize cardiopulmonary resuscitation (CPR) chest compression interruptions, some emergency medical services (EMS) practitioners utilize supraglottic airway (SGA) devices instead of endotracheal intubation (ETI) as the primary airway adjunct in out-of-hospital cardiac arrest (OHCA). We compared the outcomes of patients receiving ETI with those receiving SGA following OHCA. METHODS: We performed a secondary analysis of data from the multicenter Resuscitation Outcomes Consortium (ROC) PRIMED trial. We studied adult non-traumatic OHCA receiving successful SGA insertion (King Laryngeal Tube, Combitube, and Laryngeal Mask Airway) or successful ETI. The primary outcome was survival to hospital discharge with satisfactory functional status (Modified Rankin Scale ¡Ü3). Secondary outcomes included return of spontaneous circulation (ROSC), 24 hour survival, major airway or pulmonary complications (pulmonary edema, internal thoracic or abdominal injuries, acute lung injury, sepsis, and pneumonia). Using multivariable logistic regression, we studied the association between out-of hospital airway management method (ETI vs. SGA) and OHCA outcomes, adjusting for confounders. RESULTS: Of 10,455 adult OHCA, 8,487 (81.2%) received ETI and 1,968 (18.8%) received SGA. Survival to hospital discharge with satisfactory functional status was: ETI 4.7%, SGA 3.9%. Compared with successful SGA, successful ETI was associated with increased survival to hospital discharge (adjusted OR 1.40; 95% CI: 1.04, 1.89), ROSC (adjusted OR 1.78; 95% CI: 1.54, 2.04) and 24-hour survival (adjusted OR 1.74; 95% CI: 1.49, 2.04). ETI was not associated with secondary airway or pulmonary complications (adjusted OR 0.84; 95% CI: 0.61, 1.16). CONCLUSIONS: In this secondary analysis of data from the multicenter ROC PRIMED trial, ETI was associated with improved outcomes over SGA insertion after OHCA. An interesting side note . . . the authors report . . . ¡°In the secondary sensitivity analysis we observed higher survival among patients not receiving any successful advanced airway placement efforts . . .¡± Wang HE, Szydlo D, Stouffer J, Lin S, Carlson J, Vaillancourt C, Sears G, Verbeek R, Fowler R, Idris A, Koenig K, Christenson J, Minokadeh A, Brandt J, Rea T, the ROC Investigators, Endotracheal Intubation versus Supraglottic Airway Insertion in Out-of-Hospital Cardiac Arrest, Resuscitation (2012), doi:10.1016/j.resuscitation.2012.05.018 Kenny Navarro Dallas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2012 Report Share Posted June 15, 2012 Upon reading your interesting comments on this study, and taking into consideration I've just finished a grueling 24hr. shift, which extended into 28hrs because of paperwork, I have decided to get some sleep...........................................................................\ ................ Subject: ETI vs SGA? To: texasems-l Date: Friday, June 15, 2012, 8:50 AM  It has been a while since I stirred the pot. I'm worried about my skills becoming rusty . . . so here it is . . . A abstract from a paper just accepted for publication OBJECTIVE: To simplify airway management and minimize cardiopulmonary resuscitation (CPR) chest compression interruptions, some emergency medical services (EMS) practitioners utilize supraglottic airway (SGA) devices instead of endotracheal intubation (ETI) as the primary airway adjunct in out-of-hospital cardiac arrest (OHCA). We compared the outcomes of patients receiving ETI with those receiving SGA following OHCA. METHODS: We performed a secondary analysis of data from the multicenter Resuscitation Outcomes Consortium (ROC) PRIMED trial. We studied adult non-traumatic OHCA receiving successful SGA insertion (King Laryngeal Tube, Combitube, and Laryngeal Mask Airway) or successful ETI. The primary outcome was survival to hospital discharge with satisfactory functional status (Modified Rankin Scale ¡Ü3). Secondary outcomes included return of spontaneous circulation (ROSC), 24 hour survival, major airway or pulmonary complications (pulmonary edema, internal thoracic or abdominal injuries, acute lung injury, sepsis, and pneumonia). Using multivariable logistic regression, we studied the association between out-of hospital airway management method (ETI vs. SGA) and OHCA outcomes, adjusting for confounders. RESULTS: Of 10,455 adult OHCA, 8,487 (81.2%) received ETI and 1,968 (18.8%) received SGA. Survival to hospital discharge with satisfactory functional status was: ETI 4.7%, SGA 3.9%. Compared with successful SGA, successful ETI was associated with increased survival to hospital discharge (adjusted OR 1.40; 95% CI: 1.04, 1.89), ROSC (adjusted OR 1.78; 95% CI: 1.54, 2.04) and 24-hour survival (adjusted OR 1.74; 95% CI: 1.49, 2.04). ETI was not associated with secondary airway or pulmonary complications (adjusted OR 0.84; 95% CI: 0.61, 1.16). CONCLUSIONS: In this secondary analysis of data from the multicenter ROC PRIMED trial, ETI was associated with improved outcomes over SGA insertion after OHCA. An interesting side note . . . the authors report . . . ¡°In the secondary sensitivity analysis we observed higher survival among patients not receiving any successful advanced airway placement efforts . . .¡± Wang HE, Szydlo D, Stouffer J, Lin S, Carlson J, Vaillancourt C, Sears G, Verbeek R, Fowler R, Idris A, Koenig K, Christenson J, Minokadeh A, Brandt J, Rea T, the ROC Investigators, Endotracheal Intubation versus Supraglottic Airway Insertion in Out-of-Hospital Cardiac Arrest, Resuscitation (2012), doi:10.1016/j.resuscitation.2012.05.018 Kenny Navarro Dallas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2012 Report Share Posted June 16, 2012 Kenny, Please let us know when this is published and where. Gene ETI vs SGA? It has been a while since I stirred the pot. I'm worried about my skills becoming rusty . . . so here it is . . . A abstract from a paper just accepted for publication OBJECTIVE: To simplify airway management and minimize cardiopulmonary resuscitation (CPR) chest compression interruptions, some emergency medical services (EMS) practitioners utilize supraglottic airway (SGA) devices instead of endotracheal intubation (ETI) as the primary airway adjunct in out-of-hospital cardiac arrest (OHCA). We compared the outcomes of patients receiving ETI with those receiving SGA following OHCA. METHODS: We performed a secondary analysis of data from the multicenter Resuscitation Outcomes Consortium (ROC) PRIMED trial. We studied adult non-traumatic OHCA receiving successful SGA insertion (King Laryngeal Tube, Combitube, and Laryngeal Mask Airway) or successful ETI. The primary outcome was survival to hospital discharge with satisfactory functional status (Modified Rankin Scale ¡Ü3). Secondary outcomes included return of spontaneous circulation (ROSC), 24 hour survival, major airway or pulmonary complications (pulmonary edema, internal thoracic or abdominal injuries, acute lung injury, sepsis, and pneumonia). Using multivariable logistic regression, we studied the association between out-of hospital airway management method (ETI vs. SGA) and OHCA outcomes, adjusting for confounders. RESULTS: Of 10,455 adult OHCA, 8,487 (81.2%) received ETI and 1,968 (18.8%) received SGA. Survival to hospital discharge with satisfactory functional status was: ETI 4.7%, SGA 3.9%. Compared with successful SGA, successful ETI was associated with increased survival to hospital discharge (adjusted OR 1.40; 95% CI: 1.04, 1.89), ROSC (adjusted OR 1.78; 95% CI: 1.54, 2.04) and 24-hour survival (adjusted OR 1.74; 95% CI: 1.49, 2.04). ETI was not associated with secondary airway or pulmonary complications (adjusted OR 0.84; 95% CI: 0.61, 1.16). CONCLUSIONS: In this secondary analysis of data from the multicenter ROC PRIMED trial, ETI was associated with improved outcomes over SGA insertion after OHCA. An interesting side note . . . the authors report . . . ¡°In the secondary sensitivity analysis we observed higher survival among patients not receiving any successful advanced airway placement efforts . . .¡± Wang HE, Szydlo D, Stouffer J, Lin S, Carlson J, Vaillancourt C, Sears G, Verbeek R, Fowler R, Idris A, Koenig K, Christenson J, Minokadeh A, Brandt J, Rea T, the ROC Investigators, Endotracheal Intubation versus Supraglottic Airway Insertion in Out-of-Hospital Cardiac Arrest, Resuscitation (2012), doi:10.1016/j.resuscitation.2012.05.018 Kenny Navarro Dallas Quote Link to comment Share on other sites More sharing options...
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