TY - JOUR
T1 - Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients
T2 - A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial
AU - Battaglini, Denise
AU - Schiavetti, Irene
AU - Ball, Lorenzo
AU - Jakobsen, Janus Christian
AU - Lilja, Gisela
AU - Friberg, Hans
AU - Wendel-Garcia, Pedro David
AU - Young, Paul J.
AU - Eastwood, Glenn
AU - Chew, Michelle S.
AU - Unden, Johan
AU - Thomas, Matthew
AU - Joannidis, Michael
AU - Nichol, Alistar
AU - Lundin, Andreas
AU - Hollenberg, Jacob
AU - Hammond, Naomi
AU - Saxena, Manoj
AU - Martin, Annborn
AU - Solar, Miroslav
AU - Taccone, Fabio Silvio
AU - Dankiewicz, Josef
AU - Nielsen, Niklas
AU - Morten Grejs, Anders
AU - Wise, Matt P.
AU - Hängghi, Matthias
AU - Smid, Ondrej
AU - Patroniti, Nicolò
AU - Robba, Chiara
AU - the TTM2 trial investigators
PY - 2024/10
Y1 - 2024/10
N2 - Introduction: Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients’ outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality. Methods: Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes. Results: Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88–1.28, p = 0.54. Conclusions: In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes. Trial registration number: NCT02908308.
AB - Introduction: Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients’ outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality. Methods: Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes. Results: Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88–1.28, p = 0.54. Conclusions: In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes. Trial registration number: NCT02908308.
KW - Airway devices
KW - Airway management
KW - Cardiac arrest
KW - Outcome, endotracheal intubation
KW - Supraglottic device
U2 - 10.1016/j.resuscitation.2024.110390
DO - 10.1016/j.resuscitation.2024.110390
M3 - Article
C2 - 39244144
AN - SCOPUS:85204111354
SN - 0300-9572
VL - 203
JO - Resuscitation
JF - Resuscitation
M1 - 110390
ER -