Universität zu Köln

Wnent, Jan, Franz, Rudiger, Seewald, Stephan, Lefering, Rolf, Fischer, Matthias, Bohn, Andreas, Walther, Jorg W., Scholz, Jens, Lukas, Roman-Patrik and Grasner, Jan-Thorsten ORCID: 0000-0001-8143-0376 (2015). Difficult intubation and outcome after out-of-hospital cardiac arrest: a registry-based analysis. Scand. J. Trauma Resusc. Emerg. Med., 23. LONDON: BIOMED CENTRAL LTD. ISSN 1757-7241

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Abstract

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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wnent, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Franz, Rudiger UNSPECIFIED UNSPECIFIED UNSPECIFIED Seewald, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Lefering, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Fischer, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Bohn, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Walther, Jorg W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Scholz, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Lukas, Roman-Patrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Grasner, Jan-Thorsten UNSPECIFIED orcid.org/0000-0001-8143-0376 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-401213
DOI:	10.1186/s13049-015-0124-0
Journal or Publication Title:	Scand. J. Trauma Resusc. Emerg. Med.
Volume:	23
Date:	2015
Publisher:	BIOMED CENTRAL LTD
Place of Publication:	LONDON
ISSN:	1757-7241
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ADVANCED LIFE-SUPPORT; PREHOSPITAL ENDOTRACHEAL INTUBATION; EUROPEAN RESUSCITATION COUNCIL; AIRWAY MANAGEMENT; CARDIOPULMONARY-RESUSCITATION; EMERGENCY PHYSICIANS; RECOMMENDED GUIDELINES; UTSTEIN STYLE; SURVIVAL; CARE Multiple languages Emergency Medicine Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/40121