Association of Prehospital Advanced Airway Management With Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest
Association of Prehospital Advanced Airway Management With Neurologic Outcome and Survival in Patients With Out-of-Hospital Cardiac Arrest
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DOI：
10.1001/jama.2012.187612
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发表时间：
2013-01-16
影响因子：
120.7
通讯作者：
Brown, David F. M.
中科院分区：
文献类型：
--
作者：
Hasegawa, Kohei;Hiraide, Atsushi;Brown, David F. M.
重要性目前尚不清楚是否先进的气道管理，如气管插管或使用声门上气道装置在院前设置改善后，院外心脏骤停（OHCA）与传统的袋阀面罩ventilation.Objective. Objective. To测试假设，院前先进的气道管理与成人OHCA后的良好结果。基于人群的研究（全日本Utstein登记研究），包括2005年1月至2010年12月在日本发生OHCA的649654例连续成人患者，这些患者由紧急救援人员尝试复苏，随后被运送到医疗机构。主要结果测量OHCA后1个月良好的神经学结果，结果649359例OHCA患者中，367837例（57%）接受了气囊-阀-面罩通气，281522例（43%）接受了高级气道管理，包括41972例（6%）气管插管和239550例（37%）使用声门上气道。在整个队列中，先进气道组的良好神经功能结局发生率低于袋阀面罩组（1.1% vs 2.9%;比值比[OR]，0.38; 95%CI，0.36-0.39）。在多变量logistic回归分析中，在调整年龄、性别、呼吸骤停病因、首次记录的心律、目击状态、旁观者心肺复苏类型、使用公共通路自动体外除颤器、肾上腺素给药和时间间隔后，高级气道管理的有利神经学结局OR为0.38（95%CI，0.37-0.40）。同样，气管内插管（调整后OR，0.41; 95%CI，0.37-0.45）和声门上气道（调整后OR，0.38; 95%CI，0.36-0.40）的神经学有利生存率显著较低。在倾向评分匹配队列（357228例患者）中，气管插管（调整OR，0.45; 95%CI，0.37-0.55）和使用声门上气道（调整OR，0.36; 95%CI，0.33-0.39）的神经系统有利生存率的调整比值显著较低。气管插管和使用声门上气道同样与神经系统良好的生存率降低的几率相关。结论和相关性在OHCA成人患者中，任何类型的高级气道管理与神经系统良好的生存率降低的几率独立相关，与传统的袋阀面罩通气相比。美国医学会杂志2013;309（3）：257-266 www.jama.com
Importance It is unclear whether advanced airway management such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting improves outcomes following out-of-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask ventilation.Objective To test the hypothesis that prehospital advanced airway management is associated with favorable outcome after adult OHCA.Design, Setting, and Participants Prospective, nationwide, population-based study (All-Japan Utstein Registry) involving 649 654 consecutive adult patients in Japan who had an OHCA and in whom resuscitation was attempted by emergency responders with subsequent transport to medical institutions from January 2005 through December 2010.Main Outcome Measures Favorable neurological outcome 1 month after an OHCA, defined as cerebral performance category 1 or 2.Results Of the eligible 649 359 patients with OHCA, 367 837 (57%) underwent bag-valve-mask ventilation and 281 522 (43%) advanced airway management, including 41 972 (6%) with endotracheal intubation and 239 550 (37%) with use of supraglottic airways. In the full cohort, the advanced airway group incurred a lower rate of favorable neurological outcome compared with the bag-valve-mask group (1.1% vs 2.9%; odds ratio [OR], 0.38; 95% CI, 0.36-0.39). In multivariable logistic regression, advanced airway management had an OR for favorable neurological outcome of 0.38 (95% CI, 0.37-0.40) after adjusting for age, sex, etiology of arrest, first documented rhythm, witnessed status, type of bystander cardiopulmonary resuscitation, use of public access automated external defibrillator, epinephrine administration, and time intervals. Similarly, the odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41; 95% CI, 0.37-0.45) and for supraglottic airways (adjusted OR, 0.38; 95% CI, 0.36-0.40). In a propensity score-matched cohort (357 228 patients), the adjusted odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.45; 95% CI, 0.37-0.55) and for use of supraglottic airways (adjusted OR, 0.36; 95% CI, 0.33-0.39). Both endotracheal intubation and use of supraglottic airways were similarly associated with decreased odds of neurologically favorable survival.Conclusion and Relevance Among adult patients with OHCA, any type of advanced airway management was independently associated with decreased odds of neurologically favorable survival compared with conventional bag-valve-mask ventilation. JAMA. 2013;309(3):257-266 www.jama.com