Difficult intubation and outcome after out-of-hospital cardiac arrest: a registry-based analysis

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Jan-Thorsten Gräsner¹  Roman-Patrik Lukas⁶  Jens Scholz¹  Jörg W. Walther⁷  Andreas Bohn⁶  Matthias Fischer³  Rolf Lefering²  Stephan Seewald¹  Rüdiger Franz⁵  Jan Wnent⁴ 

[1] Department of Anesthesiology and Intensive-Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel, 24105, Germany;University of Witten/Herdecke, Faculty of Medicine, Institute for Research in Operative Medicine, Ostmerheimer Strasse 200, Haus 38, Cologne, 51109, Germany;Department of Anesthesiology and Intensive-Care Medicine, Klinik am Eichert, ALB.Fils-Kliniken, Eichertstrasse 3, Göppingen, 73035, Germany;Department of Anesthesiology and Intensive-Care Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus 13, Luebeck, 23538, Germany;Department of Anesthesiology and Intensive Care Medicine, European Medical School Oldenburg-Groningen, Oldenburg, Germany;Department of Anesthesiology and Intensive-Care Medicine, Münster University Hospital, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany;Institute for Prevention and Occupational Medicine, Ruhr-Universität Bochum, Buerkle de la Camp-Platz 1, Bochum, 44789, Germany

关键词: Airwaymanagement;    Resuscitation;    Out-of-hospital cardiac arrest;    Intubation;   

Others  :  1213811
DOI  :  10.1186/s13049-015-0124-0

 received in 2014-11-24, accepted in 2015-05-22,  发布年份 2015

【 摘 要 】

Background

Airway management during resuscitation attempts is pivotal for treating hypoxia, and endotracheal intubation is the standard procedure. This German Resuscitation Registry analysis investigates the influence of airway management on primary outcomes after out-of-hospital cardiac arrest, in a physician-based emergency system.

Methods

A total of 8512 patients recorded in the German Resuscitation Registry (2007–2011) were analyzed. The Return of Spontaneous Circulation After Cardiac Arrest (RACA) score was used to compare observed return of spontaneous circulation (ROSC) rates with the ROSC predicted by the score and to analyze factors influencing the primary outcome. Patients were classified into three groups: difficult intubation, impossible intubation, and a control group with normal airways.

Results

The observed ROSC matched the predicted ROSC in the group with difficult airways. The impossible intubation group had lower ROSC rates (31.3 % vs. 40.5 %; P < 0.05). Impossible intubation was more frequent in men (OR 2.28; 95 % CI, 1.43–3.63; P = 0.001), young patients (OR 2.18; 95 % CI, 1.26–3.76; P = 0.005) and those with trauma (OR 2.22; 95 % CI, 1.01–4.85; P = 0.046). Fewer impossible intubations were reported when the emergency physicians were anesthesiologists (OR 0.65; 95 % CI, 0.44–0.96; P = 0.028). If a supraglottic airway device was not used in the impossible intubation group, the observed ROSC (18.0 %; 95 % CI, 7.4–28.6 %) was poorer than predicted (38.2 %) (P < 0.05).

Conclusions

Outcomes after resuscitation attempts are poorer when endotracheal intubation is not possible. Predictive factors for impossible intubation are male gender, younger age, and trauma. Supraglottic airway devices should be used at an early stage whenever these negative factors are present.

【 授权许可】

   
2015 Wnent et al.

【 图 表 】

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