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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2015

Open Access 01-12-2015 | Original research

Difficult intubation and outcome after out-of-hospital cardiac arrest: a registry-based analysis

Authors: Jan Wnent, Rüdiger Franz, Stephan Seewald, Rolf Lefering, Matthias Fischer, Andreas Bohn, Jörg W. Walther, Jens Scholz, Roman-Patrik Lukas, Jan-Thorsten Gräsner, the German Resuscitation Registry Study Group

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2015

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Abstract

Background

Airway management during resuscitation attempts is pivotal for treating hypoxia, and endotracheal intubation is the standard procedure. This German Resuscitation Registry analysis investigates the influence of airway management on primary outcomes after out-of-hospital cardiac arrest, in a physician-based emergency system.

Methods

A total of 8512 patients recorded in the German Resuscitation Registry (2007–2011) were analyzed. The Return of Spontaneous Circulation After Cardiac Arrest (RACA) score was used to compare observed return of spontaneous circulation (ROSC) rates with the ROSC predicted by the score and to analyze factors influencing the primary outcome. Patients were classified into three groups: difficult intubation, impossible intubation, and a control group with normal airways.

Results

The observed ROSC matched the predicted ROSC in the group with difficult airways. The impossible intubation group had lower ROSC rates (31.3 % vs. 40.5 %; P < 0.05). Impossible intubation was more frequent in men (OR 2.28; 95 % CI, 1.43–3.63; P = 0.001), young patients (OR 2.18; 95 % CI, 1.26–3.76; P = 0.005) and those with trauma (OR 2.22; 95 % CI, 1.01–4.85; P = 0.046). Fewer impossible intubations were reported when the emergency physicians were anesthesiologists (OR 0.65; 95 % CI, 0.44–0.96; P = 0.028). If a supraglottic airway device was not used in the impossible intubation group, the observed ROSC (18.0 %; 95 % CI, 7.4–28.6 %) was poorer than predicted (38.2 %) (P < 0.05).

Conclusions

Outcomes after resuscitation attempts are poorer when endotracheal intubation is not possible. Predictive factors for impossible intubation are male gender, younger age, and trauma. Supraglottic airway devices should be used at an early stage whenever these negative factors are present.
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Metadata
Title
Difficult intubation and outcome after out-of-hospital cardiac arrest: a registry-based analysis
Authors
Jan Wnent
Rüdiger Franz
Stephan Seewald
Rolf Lefering
Matthias Fischer
Andreas Bohn
Jörg W. Walther
Jens Scholz
Roman-Patrik Lukas
Jan-Thorsten Gräsner
the German Resuscitation Registry Study Group
Publication date
01-12-2015
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-015-0124-0

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