Study objective

While often prioritized in the resuscitation of patients with out-of-hospital cardiac arrest, the optimal timing of advanced airway insertion is unknown. We evaluated the association between the timing of advanced airway (laryngeal tube and endotracheal intubation) insertion attempt and survival to hospital discharge in adult out-of-hospital cardiac arrest.

Methods

We performed a secondary analysis of the Pragmatic Airway Resuscitation Trial (PART), a clinical trial comparing the effects of laryngeal tube and endotracheal intubation on outcomes after adult out-of-hospital cardiac arrest. We stratified the cohort by randomized airway strategy (laryngeal tube or endotracheal intubation). Within each subset, we defined a time-dependent propensity score using patients, arrest, and emergency medical services systems characteristics. Using the propensity score, we matched each patient receiving an initial attempt of laryngeal tube or endotracheal intubation with a patient at risk of receiving laryngeal tube or endotracheal intubation attempt within the same minute.

Results

Of 2,146 eligible patients, 1,091 (50.8%) and 1,055 (49.2%) were assigned to initial laryngeal tube and endotracheal intubation strategies, respectively. In the propensity score-matched cohort, timing of laryngeal tube insertion attempt was not associated with survival to hospital discharge: 0 to lesser than 5 minutes (risk ratio [RR]=1.35, 95% confidence interval [CI] 0.53 to 3.44); 5 to lesser than10 minutes (RR=1.07, 95% CI 0.66 to 1.73); 10 to lesser than 15 minutes (RR=1.17, 95% CI 0.60 to 2.31); or 15 to lesser than 20 minutes (RR=2.09, 95% CI 0.35 to 12.47) after advanced life support arrival. Timing of endotracheal intubation attempt was also not associated with survival: 0 to lesser than 5 minutes (RR=0.50, 95% CI 0.05 to 4.87); 5 to lesser than10 minutes (RR=1.20, 95% CI 0.51 to 2.81); 10 to lesser than15 minutes (RR=1.03, 95% CI 0.49 to 2.14); 15 to lesser than 20 minutes (RR=0.85, 95% CI 0.30 to 2.42); or more than/equal to 20 minutes (RR=0.71, 95% CI 0.07 to 7.14).

Conclusion

In the PART, timing of advanced airway insertion attempt was not associated with survival to hospital discharge.

中文翻译：

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院外心脏骤停后高级气道插入时机和结果的关联

学习目标

虽然通常优先考虑对院外心脏骤停患者进行复苏，但高级气道插入的最佳时机尚不清楚。我们评估了高级气道（喉管和气管插管）插入尝试的时间与成人院外心脏骤停患者出院生存率之间的关系。

方法

我们对实用气道复苏试验 (PART) 进行了二次分析，这是一项比较喉管和气管插管对成人院外心脏骤停后结局影响的临床试验。我们通过随机气道策略（喉管或气管插管）对队列进行分层。在每个子集中，我们使用患者、逮捕和紧急医疗服务系统特征定义了一个时间依赖性倾向评分。使用倾向评分，我们将接受喉管或气管插管初始尝试的每位患者与同一分钟内有接受喉管或气管插管尝试风险的患者进行匹配。

结果

在 2,146 名符合条件的患者中，1,091 名（50.8%）和 1,055 名（49.2%）分别被分配到初始喉管和气管插管策略。在倾向评分匹配的队列中，尝试插入喉管的时间与出院生存率无关：0 到少于 5 分钟（风险比 [RR]=1.35，95% 置信区间 [CI] 0.53 到 3.44）；5 到少于 10 分钟（RR=1.07，95% CI 0.66 到 1.73）；10 到少于 15 分钟（RR=1.17，95% CI 0.60 到 2.31）；或在高级生命支持到达后 15 到少于 20 分钟（RR=2.09, 95% CI 0.35 到 12.47）。尝试气管插管的时间也与生存率无关：0 到少于 5 分钟（RR=0.50，95% CI 0.05 到 4.87）；5 到少于 10 分钟（RR=1.20，95% CI 0.51 到 2.81）；10 到少于 15 分钟 (RR=1.03, 95% CI 0. 49 至 2.14）；15 到少于 20 分钟（RR=0.85, 95% CI 0.30 到 2.42）；或超过/等于 20 分钟 (RR=0.71, 95% CI 0.07 to 7.14)。

结论

在 PART 中，尝试高级气道插入的时间与出院生存率无关。