OJEM  Vol.2 No.1 , March 2014
Effect of Airway Management and Impedance Threshold Device on Circulation, Survival and Neurological Outcome in Adult Out-Of-Hospital Cardiac Arrest
ABSTRACT

Purpose: This study was designed to study the effect of early use of the King Airway (KA) and impedance threshold device (ITD) in out-of-hospital cardiac arrest on ETCO2 as a surrogate measure of circulation, survival, and cerebral performance category (CPC) scores. After analysis of the first 9 month active period the KA was relegated to rescue airway status. Methods: This was a prospective pre-post study design. Patients >18 years with out-of-hospital cardiac caused arrest were included. Three periods were compared. In the first “non active” period conventional AHA 30/2 compression/ventilation ratio CPR was done with bag mask ventilation (BMV). No ITD was used. After advanced airway placement the compression/ventilation ratio was 10/1. In the second period continuous compressions were done. Primary airway management was a KA with an ITD. After placement of the KA the compression/ventilation ratio was 10/1. In the third period CPR reverted to 30/2 ratio with a two hand seal BMV with ITD. CPR ratio was 10/1 post endotracheal intubation (ETI) or KA. The KA was only recommended for failed BMV and ETI. Results: Survival to hospital discharge was similar in all three study periods. In Period 2 there was a strong trend to CPC scores >2. The study group hypothesized that the KA interfered with cerebral blood flow. For that reason the KA was abandoned as a primary airway. Comparing Period 1 to Period 3 there was a trend to improved survival in the bystander witnessed shockable rhythm (Utstein) subgroup, particularly if a metronome was used. ETCO2 was significantly increased in Period 2 and trended up in Period 3 when compared to Period 1. Advanced airway intervention had a highly significant negative association with survival. Conclusion: The introduction of an ITD into our system did not result in a statistically significant improvement in survival. The study groups were somewhat dissimilar. ETCO2 trended up. When comparing Period 1 to Period 3, the bundle of care was associated with a trend towards increased survival in the Utstein subgroup, particularly with a metronome set at 100. Multiple confounders make a definitive conclusion impossible. Advanced airways showed a significant association with poor survival outcomes. The KA was additionally associated with poor neurologic outcomes.


Cite this paper
Chase, D. , Salvucci, A. , Marino, R. , Shedlosky, R. , Merman, N. and Hadduck, K. (2014) Effect of Airway Management and Impedance Threshold Device on Circulation, Survival and Neurological Outcome in Adult Out-Of-Hospital Cardiac Arrest. Open Journal of Emergency Medicine, 2, 12-18. doi: 10.4236/ojem.2014.21003.
References
[1]   Bobrow, B.J., et al. (2008) Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of- Hospital Cardiac Arrest. JAMA, 299, 1158-1165. http://dx.doi.org/10.1001/jama.299.10.1158

[2]   Aufderheide, T.P., et al. (2007) A Tale of Seven EMS Systems: An Impedence Threshold Device and Improved CPR Techniques Double Survival Rates After Out-of-Hospital Cardiac Arrest. AHA Scientific Session.

[3]   Thigpen, K., et al. (2008) Implementation of the 2005 Cardiopulmonary Resuscitation Guidelines and Use of an Impedance Threshold Device Improve Survival from Inhospital Cardiac Arrest. Annals of Emergency Medicine, 51, 475. http://dx.doi.org/10.1016/j.annemergmed.2008.01.282

[4]   Yannopoulos, D., et al. (2007) Acute Management of Sudden Cardiac Death in Adults Based upon the New CPR Gui- delines. Europace, 9, 2-9. http://dx.doi.org/10.1093/europace/eul126

[5]   Aufderheide, T.P., et al. (2011) A Trial of an Impedance Threshold Device in Out-of-Hospital Cardiac Arrest. The New England Journal of Medicine, 365, 798-806. http://dx.doi.org/10.1056/NEJMoa1010821

[6]   Idris. American Heart Association, Scientific Sessions, Poster 2012.

[7]   Colbert, S.A., et al. (1998) The Laryngeal Mask Airway Reduces Flow in the Common Carotid Artery Bulb. Canadian Journal of Anesthesia, 45, 23-27. http://dx.doi.org/10.1007/BF03011987

[8]   Segal, N., et al. (2012) Impairment of Carotid Artery Blood Flow by Supragottic Airway Use in a Swine Model of Cardiac Arrest. Resuscitation, 83, 1025-1030. http://dx.doi.org/10.1016/j.resuscitation.2012.03.025

[9]   Wang, H.E., et al. (2012) Endotracheal Intubation versus SGA Insertion on OHCA. Resuscitation, 83, 1061-1066. http://dx.doi.org/10.1016/j.resuscitation.2012.05.018

[10]   Hasegawa, K., et al. (2013) Association of Prehospital Advanced Airway Management with Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest. JAMA, 309, 257-266. http://dx.doi.org/10.1001/jama.2012.187612

[11]   Fouche, P.F., et al. (2013) Airways in Out-of-Hospital Cardiac Arrest: Systematic Review and Meta-Analysis. Prehos- pital Emergency Care, Early Online.

[12]   Tanabe, S., et al. (2013) Comparison of Neurological Outcome between Tracheal Intubation and Supraglottic Airway Device Insertion of Out-of-Hospital Cardiac Arrest Patients. The Journal of Emergency Medicine, 44, 389-397. http://dx.doi.org/10.1016/j.jemermed.2012.02.026

[13]   Yeung, J., et al. (2009) The Use of CPR Feedback/Prompt Devices during Training and CPR Performance: A Systematic Review. Resuscitation, 80, 743-751. http://dx.doi.org/10.1016/j.resuscitation.2009.04.012

 
 
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