Prehospital endotracheal intubation and survival after out-of-hospital cardiac arrest: results from the Korean nationwide registry.

PURPOSE: Optimal out-of-hospital cardiac arrest (OHCA) airway management strategies are still controversial. Recent studies reported survival was higher among patients who received bag-valve-mask (BVM) than those receiving endotracheal intubation (ETI) or supraglottic airway (SGA). The aim of this study was to compare neurologically favorable survival outcomes among adult nontraumatic OHCA patients by prehospital airway.

METHODS: We used the Korean nationwide OHCA cohort database from 2010 to 2013. The inclusion criteria were all OHCA adults with presumed cardiac etiology, resuscitated by level-1 emergency medical technician. Patients were excluded if their information about the method of prehospital airway or clinical outcomes at hospital discharge could not be captured. The primary outcome was neurologically favorable survival to discharge. We compared the outcomes among 3 groups (ETI, SGA, or BVM) by prehospital airway using multivariable logistic regression with interaction model.

RESULTS: Of 98896 patients with OHCA, 32513 were included in analysis. Patients receiving BVM were 29684 and 2829 underwent advanced airway management including 1634 with SGA and 1195 with ETI. The odds of neurologically favorable survival to discharge was significantly higher in the ETI group compared to the BVM group (adjusted OR, 1.405; 95% CI, 1.1001-1.971). In the interaction model by witnessed status, the effect of ETI on good clinical outcomes was shown only in the patients whose arrest was unwitnessed.

CONCLUSION: In this Korean nationwide, population-based OHCA cohort, neurologically favorable survival to hospital discharge rates was significantly higher among patients who received ETI than those receiving BVM or SGA.