Airway strategy and chest compression quality in the Pragmatic Airway Resuscitation Trial

Chest compression (CC) quality is associated with improved out-of-hospital cardiopulmonary arrest (OHCA) outcomes. Airway management efforts may adversely influence CC quality. We sought to compare the effects of initial laryngeal tube (LT) and initial endotracheal intubation (ETI) airway management...

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Bibliographic Details
Published in:Resuscitation 2021-05, Vol.162, p.93-98
Main Authors: Wang, Henry E., Jaureguibeitia, Xabier, Aramendi, Elisabete, Jarvis, Jeffrey L., Carlson, Jestin N., Irusta, Unai, Alonso, Erik, Aufderheide, Tom, Schmicker, Robert H., Hansen, Matthew L., Huebinger, Ryan M., Colella, M. Riccardo, Gordon, Richard, Suchting, Robert, Idris, Ahamed H.
Format: Article
Language:English
Subjects:
Adult
Airway Management
Cardiopulmonary arrest
Cardiopulmonary Resuscitation
Emergency medical service
Emergency Medical Services
Humans
Intubation
Intubation, Intratracheal
Out-of-Hospital Cardiac Arrest - therapy
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Summary:Chest compression (CC) quality is associated with improved out-of-hospital cardiopulmonary arrest (OHCA) outcomes. Airway management efforts may adversely influence CC quality. We sought to compare the effects of initial laryngeal tube (LT) and initial endotracheal intubation (ETI) airway management strategies upon chest compression fraction (CCF), rate and interruptions in the Pragmatic Airway Resuscitation Trial (PART). We analyzed CPR process files collected from adult OHCA enrolled in PART. We used automated signal processing techniques and a graphical user interface to calculate CC quality measures and defined interruptions as pauses in chest compressions longer than 3 s. We determined CC fraction, rate and interruptions (number and total duration) for the entire resuscitation and compared differences between LT and ETI using t-tests. We repeated the analysis stratified by time before, during and after airway insertion as well as by successive 3-min time segments. We also compared CC quality between single vs. multiple airway insertion attempts, as well as between bag-valve-mask (BVM-only) vs. ETI or LT. Of 3004 patients enrolled in PART, CPR process data were available for 1996 (1001 LT, 995 ETI). Mean CPR analysis duration were: LT 22.6 ± 10.8 min vs. ETI 25.3 ± 11.3 min (p 
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2021.01.043