Type of advanced airway and survival after pediatric out-of-hospital cardiac arrest.

Adolescent Airway Management Cardiopulmonary Resuscitation Child Emergency Medical Services Female Humans Intubation, Intratracheal Japan / epidemiology Male Out-of-Hospital Cardiac Arrest / therapy
Cardiopulmonary resuscitation Children Endotracheal intubation Out-of-hospital cardiac arrest Pediatrics Supraglottic airway device

Journal

Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173

Informations de publication

Date de publication:
05 2020
Historique:
received: 09 12 2019
revised: 29 01 2020
accepted: 06 02 2020
pubmed: 20 2 2020
medline: 22 6 2021
entrez: 20 2 2020
Statut: ppublish

Résumé

There is a knowledge gap about advanced airway management (AAM) after pediatric out-of-hospital cardiac arrest (OHCA) in the prehospital setting. We assessed which AAM strategy would be associated with an increased chance of survival after pediatric OHCA. A nationwide population-based observational study was conducted using the Japanese government-led registry data of OHCA. Pediatric OHCA patients (aged 1-17 years) who received prehospital AAM via endotracheal intubation (ETI) or supraglottic airway (SGA) insertion by emergency medical service (EMS) personnel from 2011 to 2017 were included. Patients who received ETI were compared with those who received SGA insertion. The primary outcome was one-month survival after OHCA. A total of 967 patients (mean [SD] age, 12.2 [5.1] years; 66.6% male) were included; 113 received ETI, and 854 received SGA insertion. Among the total cohort, 118 (12.2%) survived one month after OHCA. In the propensity score-matched cohort, no difference was observed in one-month survival between the ETI and SGA insertion groups: 13 of 113 patients (11.5%) vs 12 of 113 patients (10.6%); RR, 1.08; 95%CI, 0.52-2.27. This lack of association between AAM strategy and survival was observed across a variety of subgroup and sensitivity analyses, and also for neurologically favorable survival (P = 0.5611) in the propensity score-matched analysis. In Japan, among pediatric OHCA patients, there was no significant difference in one-month survival between prehospital ETI and SGA insertion by EMS personnel. Although an adequately powered randomized controlled trial is needed, EMS personnel may choose their familiar strategy when prehospital AAM was performed during pediatric OHCA.

Sections du résumé

BACKGROUND
There is a knowledge gap about advanced airway management (AAM) after pediatric out-of-hospital cardiac arrest (OHCA) in the prehospital setting. We assessed which AAM strategy would be associated with an increased chance of survival after pediatric OHCA.
METHODS
A nationwide population-based observational study was conducted using the Japanese government-led registry data of OHCA. Pediatric OHCA patients (aged 1-17 years) who received prehospital AAM via endotracheal intubation (ETI) or supraglottic airway (SGA) insertion by emergency medical service (EMS) personnel from 2011 to 2017 were included. Patients who received ETI were compared with those who received SGA insertion. The primary outcome was one-month survival after OHCA.
RESULTS
A total of 967 patients (mean [SD] age, 12.2 [5.1] years; 66.6% male) were included; 113 received ETI, and 854 received SGA insertion. Among the total cohort, 118 (12.2%) survived one month after OHCA. In the propensity score-matched cohort, no difference was observed in one-month survival between the ETI and SGA insertion groups: 13 of 113 patients (11.5%) vs 12 of 113 patients (10.6%); RR, 1.08; 95%CI, 0.52-2.27. This lack of association between AAM strategy and survival was observed across a variety of subgroup and sensitivity analyses, and also for neurologically favorable survival (P = 0.5611) in the propensity score-matched analysis.
CONCLUSIONS
In Japan, among pediatric OHCA patients, there was no significant difference in one-month survival between prehospital ETI and SGA insertion by EMS personnel. Although an adequately powered randomized controlled trial is needed, EMS personnel may choose their familiar strategy when prehospital AAM was performed during pediatric OHCA.

Identifiants

DOI: 10.1016/j.resuscitation.2020.02.005 PMID: 32070779
pubmed: 32070779
pii: S0300-9572(20)30067-8
doi: 10.1016/j.resuscitation.2020.02.005
pii:
doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

145-153

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Auteurs

Tatsuma Fukuda (T)

Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan. Electronic address: tatsumafukuda-jpn@umin.ac.jp.

Hiroshi Sekiguchi (H)

Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.

Takayuki Taira (T)

Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Department of Anesthesiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.

Naoki Hashizume (N)

Department of Pediatric Surgery, Kurume University School of Medicine, Fukuoka, Japan; Department of Pediatric Surgery, Tsuruoka Municipal Shonai Hospital, Yamagata, Japan.

Yusuke Kitamura (Y)

Department of Pediatrics, Kochi Prefectural Aki General Hospital, Kochi, Japan.

Taizo Terada (T)

Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Emergency Medical Center, Department of Emergency Medicine, Naha City Hospital, Okinawa, Japan.

Naoko Ohashi-Fukuda (N)

Regional Perinatal Medical Center, Department of Obstetrics and Gynecology, Naha City Hospital, Okinawa, Japan; Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Ichiro Kukita (I)

Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Department of Medical Engineering, University of the Ryukyus Hospital, Okinawa, Japan.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Type of advanced airway and survival after...
questionsmedicales.fr › Thérapeutique › Prise en charge des voies aériennes › Type of advanced airway and survival after...
questionsmedicales.fr › Thérapeutique › Traitement d'urgence › Réanimation › Réanimation cardiopulmonaire › Type of advanced airway and survival after...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Type of advanced airway and survival after...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Type of advanced airway and survival after...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Type of advanced airway and survival after...
questionsmedicales.fr › Techniques d'investigation › Intubation › Intubation trachéale › Type of advanced airway and survival after...
questionsmedicales.fr › Régions géographiques › Iles › Japon › Type of advanced airway and survival after...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Arrêt cardiaque › Arrêt cardiaque hors hôpital › Type of advanced airway and survival after...