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The effect of airway management on CPR quality in the PARAMEDIC2 randomised controlled trial

      Abstract

      Introduction

      Good quality basic life support (BLS) is associated with improved outcome from cardiac arrest. Chest compression fraction (CCF) is a BLS quality indicator, which may be influenced by the type of airway used. We aimed to assess CCF according to the airway strategy in the PARAMEDIC2 study: no advanced airway, supraglottic airway (SGA), tracheal intubation, or a combination of the two. Our hypothesis was that tracheal intubation was associated with a decrease in the CCF compared with alternative airway management strategies.

      Methods

      PARAMEDIC2 was a multicentre double-blinded placebo-controlled trial of adrenaline vs placebo in out-of-hospital cardiac arrest. Data showing compression rate and ratio from patients recruited by London Ambulance Service (LAS) as part of this study was collated and analysed according to the advanced airway used during the resuscitation attempt.

      Results

      CPR process data were available from 286/ 2058 (13.9%) of the total patients recruited by LAS. The mean compression rate for the first 5 min of data recording was the same in all groups (P = 0.272) and ranged from 104.2 (95% CI of mean: 100.5, 107.8) min−1 to 108.0 (95% CI of mean: 105.1, 108.3) min−1. The mean compression fraction was also similar across all groups (P = 0.159) and ranged between 74.7% and 78.4%. There was no difference in the compression rates and fractions across the airway management groups, regardless of the duration of CPR.

      Conclusion

      There was no significant difference in the compression fraction associated with the airway management strategy.

      Keywords

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      References

      1. Adnet F. Initial airway management in patients with out- of-hospital cardiac arrest: tracheal intubation vs. bag- mask ventilation [cited 24 Jan 2018]. Available online: http://www.clinicaltrialresults.org/Slides/ESC2017/CAAM%20TIAL_Adnet.pdf#search=%27CAAM+NCT02327026%27.

        • Benger J.R.
        • Kirby K.
        • Black S.
        • et al.
        Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial.
        JAMA. 2018; 320: 779-791
        • Wang H.E.
        • Schmicker R.H.
        • Daya M.R.
        • et al.
        Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial.
        JAMA. 2018; 320: 769-778
        • Christenson J.
        • Andrusiek D.
        • Everson-Stewart S.
        • et al.
        Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation.
        Circulation. 2009; 120: 1241-1247
        • Vaillancourt C.
        • Everson-Stewart S.
        • Christenson J.
        • et al.
        The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation.
        Resuscitation. 2011; 82: 1501-1507
        • Brouwer T.F.
        • Walker R.G.
        • Chapman F.W.
        • Koster R.W.
        Association between chest compression interruptions and clinical outcomes of ventricular fibrillation out-of-hospital cardiac arrest.
        Circulation. 2015; 132: 1030-1037
        • Wang H.E.
        • Simeone S.J.
        • Weaver M.D.
        • Callaway C.W.
        Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation.
        Ann Emerg Med. 2009; 54 (645–52.e1)
        • Kurz M.C.
        • Prince D.K.
        • Christenson J.
        • et al.
        Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest.
        Resuscitation. 2016; 98: 35-40
        • Jarman A.F.
        • Hopkins C.L.
        • Hansen J.N.
        • Brown J.R.
        • Burk C.
        • Youngquist S.T.
        Advanced airway type and its association with chest compression interruptions during out-of-hospital cardiac arrest resuscitation attempts.
        Prehosp Emerg Care. 2017; 21: 628-635
        • Malinverni S.
        • Bartiaux M.
        • Cavallotto F.
        • et al.
        Does endotracheal intubation increases chest compression fraction in out of hospital cardiac arrest: a substudy of the CAAM trial.
        Resuscitation. 2019; 137: 35-40
        • Perkins G.D.
        • Ji C.
        • Deakin C.D.
        • et al.
        A randomized trial of epinephrine in out-of-hospital cardiac arrest.
        N Engl J Med. 2018; 379: 711-721
        • Perkins G.D.
        • Quinn T.
        • Deakin C.D.
        • et al.
        Pre-hospital assessment of the role of adrenaline: measuring the effectiveness of drug administration in cardiac arrest (PARAMEDIC-2): trial protocol.
        Resuscitation. 2016; 108: 75-81
        • Perkins G.D.
        • Kenna C.
        • Ji C.
        • et al.
        The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: findings from the PACA and PARAMEDIC-2 randomised controlled trials.
        Resuscitation. 2019; 140: 55-63
        • Perkins G.D.
        • Kenna C.
        • Ji C.
        • et al.
        The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial.
        Intensive Care Med. 2020; 46: 426-436
        • Nolan J.P.
        • Deakin C.D.
        • Ji C.
        • et al.
        Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled.
        Intensive Care Med. 2020; 46: 954-962
        • Yeung J.
        • Chilwan M.
        • Field R.
        • Davies R.
        • Gao F.
        • Perkins G.D.
        The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.
        Resuscitation. 2014; 85: 898-904
        • Kudenchuk P.J.
        • Brown S.P.
        • Daya M.
        • et al.
        Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest.
        N Engl J Med. 2016; 374: 1711-1722
        • Nichol G.
        • Leroux B.
        • Wang H.
        • et al.
        Trial of continuous or interrupted chest compressions during CPR.
        N Engl J Med. 2015; 373: 2203-2214
        • Maignan M.
        • Koch F.X.
        • Kraemer M.
        • et al.
        Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study.
        Resuscitation. 2015; 93: 113-117
        • Esibov A.
        • Banville I.
        • Chapman F.W.
        • Boomars R.
        • Box M.
        • Rubertsson S.
        Mechanical chest compressions improved aspects of CPR in the LINC trial.
        Resuscitation. 2015; 91: 116-121
        • Wik L.
        • Kramer-Johansen J.
        • Myklebust H.
        • et al.
        Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.
        JAMA. 2005; 293: 299-304