German Study on Optimal Airway in Cardiac Arrest


Forum Asst. Chief
In a large, retrospective registry analysis of 14,805 patients over 10 years (2007-2017), endotracheal intubation was associated with significantly higher neurologically-intact survival compared to a laryngeal tube only.

In pre-print in Resuscitation, the study looks at non-witnessed, adult, non-traumatic OHCA (where interestingly, patients with automated chest compression devices were excluded from analysis). Importantly, German EMS systems have a physician responding to these calls and arrives "simultaneously or shortly after" the paramedics do. The intubation was "mainly performed by EMS physicians, although some patients had the procedure done by paramedics."

Of note, the study seems to differentiate between a "laryngeal tube" (what was studied) and a "laryngeal mask", which was an exclusion criteria. Additionally, the study excluded those patients whose airways was managed by BVM only.

Of the ~15,000 patients analyzed, 71.7% received ETT, 19.3% a laryngeal tube (LT), and 9.0% a laryngeal tube-to-ETT (LTEX). In a comparison of ETT vs LT, patients had statistically significantly higher ROSC (45.2% vs. 34.9%, OR 1.54) and survival-to-discharge neurologically intact [CPC 1 or 2] (7.7% vs 5.8%, OR 1.35). LTEX was better than LT only in all short-term outcomes. LTEX was superior to ETT in short term outcomes (ROSC 61.4% vs. 51.1%, OR 1.53; 24h survival 34.6% vs. 30.4%, OR 1.21) but no significant differences in long-term outcome (neurologically intact survival 9.6% vs 9.9%, OR 0.96).