Laryngeal Tube Insertion Beats Endotracheal Intubation in OHCA
TUESDAY, Aug. 28, 2018 -- For patients with out-of-hospital cardiac arrest (OHCA), 72-hour survival is better with initial laryngeal tube (LT) insertion compared to endotracheal intubation (ETI), while a supraglottic airway device (SGA) is no better than tracheal intubation (TI) for functional outcome at 30 days, according to two studies published in the Aug. 28 issue of the Journal of the American Medical Association.
Henry E. Wang, M.D., from the University of Texas Health Science Center at Houston, and colleagues compared the effectiveness of an initial LT insertion versus initial ETI in 3,004 adults with OHCA (1,505 and 1,499 patients, respectively). The researchers found that the rates of initial airway success were 90.3 and 51.6 percent with LT and ETI, respectively. Seventy-two hour survival was 18.3 and 15.4 percent in the LT and ETI groups, respectively (adjusted difference, 2.9 percent; 95 percent confidence interval, 0.2 to 5.6 percent; P = 0.04).
Jonathan R. Benger, M.D., from the University of the West of England in Bristol, U.K., and colleagues randomized paramedics to use SGA (759 paramedics; 4,886 patients) or TI (764 paramedics; 4,410 patients) as the initial advanced airway management strategy in OHCA. The researchers found that 6.4 and 6.8 percent of patients in the SGA and TI groups, respectively, had a good outcome (modified Rankin Scale score range, 0 to 3) at hospital discharge or 30 days after OHCA (adjusted risk difference, −0.6 percent; 95 percent confidence interval, −1.6 to 0.4 percent).
"Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced airway management with a supraglottic airway device compared with tracheal intubation did not result in a favorable functional outcome at 30 days," Benger and colleagues write.
Several authors from the Wang study disclosed financial ties to the medical device industry.
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Posted: August 2018