Advanced airway management
The AIRWAYS 2 study was a multi-centre, cluster-randomized clinical trial of paramedics from 4 ambulance services in England3. Paramedics were randomized 1:1 to use tracheal intubation (TI) or supraglottic airways (SGA) as their initial advanced airway management strategy.
The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration.
A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled. In the SGA group 6.4% had a good outcome vs 6.8% in the TI group (adjusted risk difference [RD], -0.6% [95% CI, -1.6%0.4%]). Initial ventilation was successful in 87.4% in the SGA group compared to 79.0% in the TI group (adjusted RD 8.3% [95% CI 6.3%10.2%]) Interestingly, patients randomized to receive TI were less likely to receive advanced airway management (77.6% vs 85.2%) than in the SGA group. The authors put this down to OOHCA not always occurring where there is adequate access to intubate. Regurgitation and aspiration were not significantly different between groups (regurgitation 26.1% in SGA group vs 24.5% in the TI group [RD 1.4% [95% CI -0.6%3.4%], aspiration 15.1% vs 14.9% RD 0.1% [95% CI, -1.5%1.8%]).
The authors conclude that amongst patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced airway management with a supraglottic airway device compared with tracheal intubation did not result in a favourable functional outcome at 30 days.3