Prehospital Airway Management Method as a Predictor of Early and Definitive Survival in Patients After OHCA

Background and Objective: Out-of-hospital cardiac arrest is associated with high mortality, with prolonged cerebral hypoxia being one of the leading causes of death. The primary objective of this study was to evaluate the probability of survival during hospitalization in OHCA patients and to compare survival outcomes based on the prehospital airway management method-specifically, endotracheal intubation versus supraglottic airway devices. Material and Methods: A retrospective analysis was conducted using medical records of patients admitted to the Emergency Department of the Voivodeship Hospital in Bielsko-Biala between 1 January 2020 and 28 February 2024. The study included 61 OHCA patients who achieved the return of spontaneous circulation and had complete documentation regarding their airway management. Early and definitive survival were evaluated using a logistic regression model (adjusted for age and sex), and survival probabilities over time were estimated using the Kaplan-Meier method. Results: The analysis revealed no statistically significant difference in early survival between patients managed with an endotracheal tube and those managed with an SGA device (RR = 0.80; p = 0.598). Similarly, no significant difference was observed for definitive survival to hospital discharge (RR = 1.13; p = 0.836). Kaplan-Meier survival curves indicated a sharp decline in overall survival probability during the initial days of hospitalization, but the log-rank test (p = 0.600) confirmed the lack of significant differences in survival trajectories between the two airway management groups. Patient age was the only statistically significant factor influencing early survival, with the probability decreasing by an average of 3% for each advancing year. Conclusions: The study did not demonstrate any superiority of the endotracheal tube over supraglottic airway devices regarding the in-hospital survival of OHCA patients. The decision regarding prehospital airway management should be individualized, taking into account the operator's experience and the critical need to minimize interruptions in chest compressions during advanced life support.