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Advanced Airway Practice Patterns and Out-of-Hospital Cardiac Arrest Outcomes.

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Advanced airway (AA) practices in out-of-hospital cardiac arrest (OHCA) care varied, with a shift towards supraglottic airway (SGA) devices. Transitioning to SGA use was linked to improved survival in lower-performing emergency medical service (EMS) agencies.

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Area of Science:

  • Emergency medicine
  • Cardiology
  • Public health

Background:

  • Advanced airway (AA) management is critical in out-of-hospital cardiac arrest (OHCA) care.
  • Temporal practice patterns of AA interventions by emergency medical service (EMS) agencies have evolved.
  • The impact of these evolving AA practice patterns on OHCA outcomes remains unclear.

Purpose of the Study:

  • To investigate the association between temporal advanced airway (AA) practice patterns of emergency medical service (EMS) agencies and out-of-hospital cardiac arrest (OHCA) outcomes.
  • To analyze how different AA strategies (endotracheal intubation vs. supraglottic airway) over time correlate with patient survival and return of spontaneous circulation (ROSC).

Main Methods:

  • A cross-sectional study utilizing data from the Cardiac Arrest Registry to Enhance Survival (CARES) database.
  • Included adults (≥18 years) with OHCA treated by EMS agencies with ≥25 annual OHCA episodes (2016-2022).
  • EMS agencies were categorized by predominant AA use patterns: ongoing endotracheal intubation (ETI), ongoing supraglottic airway (SGA) use, ETI to SGA transition, and SGA to ETI transition.
  • Mixed-effects logistic regression models analyzed associations between AA patterns and OHCA outcomes (ROSC, survival), adjusting for Utstein variables and EMS agency clustering.

Main Results:

  • The study analyzed 350,216 OHCA patients from 254 EMS agencies.
  • Supraglottic airway (SGA) use increased among EMS agencies from 2016 to 2022.
  • While return of spontaneous circulation (ROSC) declined across all groups post-2019, agencies transitioning from endotracheal intubation (ETI) to SGA use showed improved ROSC and survival, particularly those with lower baseline survival rates.

Conclusions:

  • Supraglottic airway (SGA) device use has become more prevalent in emergency medical services (EMS) over time.
  • Despite an overall decline in return of spontaneous circulation (ROSC), a transition towards SGA use in lower-performing EMS agencies was associated with better outcomes.
  • Further research is needed to validate these findings and explore their applicability across diverse patient populations.