Use of rapid sequence intubation predicts improved survival among patients intubated after out-of-hospital cardiac arrest |
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Authors: | Heemun Kwok Matthew Prekker Andreas Grabinsky David Carlbom Thomas D. Rea |
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Affiliation: | 1. Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States;2. Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, United States;3. Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, United States;4. Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA, United States;5. King County Emergency Medical Services Division, Seattle King County Department of Public Health, Seattle, WA, United States |
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Abstract: | ObjectiveSome observational studies indicate that endotracheal intubation is associated with a worse outcome compared to bag-mask ventilation after out-of-hospital cardiac arrest in emergency medical services (EMS) systems without rapid sequence intubation (RSI). We evaluated the role of RSI in airway management following cardiac arrest.MethodsWe conducted a cohort study of all non-traumatic arrest patients treated by a metropolitan EMS system from 2007 to 2011. Advanced airway management information was obtained from a prospective airway registry and linked to a cardiac arrest registry. We used multivariate logistic regression to estimate the association between attempted intubation status and survival to hospital discharge.ResultsOf 3133 patients, 82% underwent attempted intubation without RSI, 15% underwent attempted RSI, and 3% experienced no intubation attempt. Survival to hospital discharge differed by attempted intubation status: 11% (n = 291/2576) for intubation without RSI, 48% (n = 226/471) for RSI, and 71% (n = 61/86) for “no intubation.” Compared to the intubation without RSI group, the adjusted odds ratios of survival were 5.6 (95% CI 4.3, 7.2) for the RSI group and 15 (95% CI 9, 27) for the “no intubation” group.ConclusionIn this population-based cohort of out-of-hospital cardiac arrest, RSI was used in 15% of patients and associated with a better prognosis than intubation attempted without paralytics. Because this subset with a favorable prognosis may not be readily intubated in systems without paralytics, these findings could help to explain the adverse relationship between intubation and survival observed in prior studies. |
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Keywords: | Cardiopulmonary resuscitation Heart arrest Airway management |
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