Category: EMS
Keywords: cardiac arrest, ECMO, E-CPR, mechanical ventilation (PubMed Search)
Posted: 4/3/2024 by Ben Lawner, MS, DO
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BACKGROUND:
The ideal strategy for out of hospital ventilation is a matter of long standing debate and clinical controversy. To date, improved out of hospital outcomes have been associated with non invasive (BVM) and supraglottic airway (SGA) management strategies. A recent, prospective trial featured in Resuscitation offers a slightly different perspective. The trial enrolled 420 adult patients with refractory out of hospital cardiac arrest due to a shockable rhythm. The study looked at outcomes for patients who received endotracheal intubation (ETI) or supraglottic airway placement. Importantly, the study involved a high volume cannulation center and codified screening criteria for eCPR including: a) ongoing arrest despite 3 shocks, b) treatment with amiodarone, c) mechanical CPR and d) anticipated time to arrival at ECMO cannulation center of <30 minutes.
OUTCOMES:
Compared to patients in the SGA group, patients receiving ETI demonstrated:
In accordance with the study institution's cannulation criteria, more patients in the SGA group were deemed ineligible for ECMO.
BOTTOM LINE:
In this single center study, patients who received ETI as a primary strategy for out of hospital airway management were more likely to meet ECMO eligibility critera and exhibit improved oxygenation and ventilation.
While this is not necessarily a practice changing article, it illustrates the complexities inherent in out of hospital cardiac arrest management. EMS has largely transitioned from a “scoop and run” cardiac arrest strategy to a plan that emphasizes treat in place. For patients who may benefit from E-CPR, additional research is indicated to shed light on best out of hospital resuscitation (and airway management) practices.
Bartos JA, Clare Agdamag A, Kalra R, Nutting L, Frascone RJ, Burnett A, Vuljaj N, Lick C, Tanghe P, Quinn R, Simpson N, Peterson B, Haley K, Sipprell K, Yannopoulos D. Supraglottic airway devices are associated with asphyxial physiology after prolonged CPR in patients with refractory Out-of-Hospital cardiac arrest presenting for extracorporeal cardiopulmonary resuscitation. Resuscitation. 2023 May;186:109769. doi: 10.1016/j.resuscitation.2023.109769. Epub 2023 Mar 17. PMID: 36933882.
