Time to invasive airway placement and resuscitation outcomes after inhospital cardiopulmonary arrest

UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, USA.
Resuscitation (Impact Factor: 3.96). 12/2009; 81(2):182-6. DOI: 10.1016/j.resuscitation.2009.10.027
Source: PubMed

ABSTRACT Clinicians often place high priority on invasive airway placement during cardiopulmonary resuscitation. The benefit of early vs. later invasive airway placement remains unknown. In this study we examined the association between time to invasive airway (TTIA) placement and patient outcomes after inhospital cardiopulmonary arrest (CPA).
We analyzed data from the National Registry of Cardiopulmonary Resuscitation (NRCPR). We included hospitalized adult patients receiving attempted invasive airway placement (endotracheal intubation, laryngeal mask airway, tracheostomy, and cricothyrotomy) after the onset of CPA. We excluded cases in which airway insertion was attempted after return of spontaneous circulation (ROSC). We defined TTIA as the elapsed time from CPA recognition to accomplishment of an invasive airway. The primary outcomes were ROSC, 24-h survival, and survival to hospital discharge. We used multivariable logistic regression to evaluate the association between the patient outcome and early (<5 min) vs. later (> or =5 min) TTIA, adjusted for hospital location, patient age and gender, first documented pulseless ECG rhythm, precipitating etiology and witnessed arrest.
Of 82,649 CPA events, we studied the 25,006 cases in which TTIA was recorded and the inclusion criteria were met. Observations were most commonly excluded for not having an invasive airway emergently placed during resuscitation. The mean time to invasive airway placement was 5.9 min (95% CI: 5.8-6.0). Patient outcomes were: ROSC 50.3% (49.7-51.0%), 24-h survival 33.7% (33.1-34.3%), survival to discharge 15.3% (14.9-15.8%). Early TTIA was not associated with ROSC (adjusted OR: 0.96, 0.91-1.01) but was associated with better odds of 24-h survival (adjusted OR: 0.94, 0.89-0.99). The relationships between TTIA and survival to discharge could not be determined.
Early invasive airway insertion was not associated with ROSC but was associated with slightly improved 24-h survival. Early invasive airway management may or may not improve inhospital cardiopulmonary resuscitation outcomes.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. Methods Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (Endotracheal tube [ET] or Laryngeal mask airway[LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. Results One hundred patients were enrolled in the study (2008 to 2011). Endotracheal tube and LMA placement took similar durations (median 15.8s (IQR 6.8-19.4) vs LMA median 8.0s (IQR 5.5-15.9), p = 0.1). The use of an advanced airway was associated with improved no flow ratios (Endotracheal tube placement (n = 50) improved NFR from baseline median 0.24 (IQR 0.17 - 0.40 to 0.15) to (IQR 0.09-0.28), p = 0.012; LMA (n = 25) from median 0.28 (IQR 0.23 - 0.40) to 0.13 (IQR 0.11 - 0.19), p = 0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n = 25) median 0.29 (IQR 0.18 - 0.59) versus median 0.26 (IQR 0.12 -0.37), p = 0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups Conclusion The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes.
    Resuscitation 07/2014; 85(7). DOI:10.1016/j.resuscitation.2014.02.018 · 3.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Perioperative cardiopulmonary arrests are uncommon and little is known about rates and predictors of in-hospital survival. Using the Get With The Guidelines®-Resuscitation national in-hospital resuscitation registry, we identified all patients aged 18 yr or older who experienced an index, pulseless cardiac arrest in the operating room or within 24 h postoperatively. The primary outcome was survival to hospital discharge, and the secondary outcome was neurologically intact recovery among survivors. Multivariable logistic regression models using generalized estimating equation models were used to identify independent predictors of survival and neurologically intact survival. A total of 2,524 perioperative cardiopulmonary arrests were identified from 234 hospitals. The overall rate of survival to discharge was 31.7% (799/2,524), including 41.8% (254/608) for ventricular tachycardia and ventricular fibrillation, 30.5% (296/972) for asystole, and 26.4% (249/944) for pulseless electrical activity. Ventricular fibrillation and pulseless ventricular tachycardia were independently associated with improved survival. Asystolic arrests occurring in the operating room and postanesthesia care unit were associated with improved survival when compared to other perioperative locations. Among patients with neurological status assessment at discharge, the rate of neurologically intact survival was 64.0% (473/739). Prearrest neurological status at admission, patient age, inadequate natural airway, prearrest ventilatory support, duration of event, and event location were significant predictors of neurological status at discharge. Among patients with a perioperative cardiac arrest, one in three survived to hospital discharge, and good neurological outcome was noted in two of three survivors.
    Anesthesiology 04/2013; DOI:10.1097/ALN.0b013e318289bafe · 6.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate whether nursing staff can successfully use the I-gel and the intubating laryngeal mask Fastrach (ILMA) during cardiopulmonary resuscitation. Although tracheal intubation is considered to be the optimal method for securing the airway during cardiopulmonary resuscitation, laryngoscopy requires a high level of skill. Forty five nurses inserted the I-gel and the ILMA in a manikin, with continuous and without chest compressions. Mean intubation times for the ILMA and I-gel without chest compressions were 20.60 ± 3.27 and 18.40 ± 3.26 s, respectively (p < 0.0005). ILMA proved more successful than the I-gel regardless of compressions. Continuation of compressions caused a prolongation in intubation times for both the I-gel (p < 0.0005) and the ILMA (p < 0.0005). In this mannequin study, nursing staff can successfully intubate using the I-gel and the ILMA as conduits with comparable success rates, regardless of whether chest compressions are interrupted or not.
    Heart & lung: the journal of critical care 01/2014; 43(2):112-6. DOI:10.1016/j.hrtlng.2013.12.004 · 1.32 Impact Factor

Full-text (2 Sources)

1 Download
Available from
Mar 31, 2015