Effect of Advanced Airway Management by Paramedics During Out-of-Hospital Cardiac Arrest on Chest Compression Fraction and Return of Spontaneous Circulation

Abstract

Koji Shimizu, Masahiro Wakasugi, Toshiomi Kawagishi, Tomoya Hatano, Takamasa Fuchigami, Hiroshi Okudera Emergency and Disaster Medicine, University of Toyama, Toyama, JapanCorrespondence: Masahiro WakasugiEmergency and Disaster Medicine, University of Toyama, 930-0194 Sugitani, Toyama, JapanTel [phone]Fax [phone]Email [email protected]: To obtain effective systemic blood flow and coronary perfusion by chest compressions during cardiopulmonary resuscitation, it is recommended that the interruption time of chest compressions be kept to a minimum, and that the chest compression fraction (CCF) should be kept high. In this study, we examined the effects of advanced airway management by paramedics in out-of-hospital cardiac arrest (OHCA) cases on CCF and on return of spontaneous circulation (ROSC) before arrival at the hospital.Participants and Methods: A total of 283 adult, non-traumatic OHCA cases who were in cardiopulmonary arrest at the time of EMS contact between April 2015 and March 2017 were registered for this study. We retrospectively investigated the presence or absence of advanced airway clearance, CCF and ROSC during CPR. CCF was calculated by measuring the chest compression interruption time from the ECG waveform recorded on a semiautomatic defibrillator (Philips HeartStart MRX). The data obtained were recorded on a computer, and comparisons between groups were examined using an untested t-test and χ2- test.Results: Of the 283 patients with OHCA, 159 were included in the analysis. The CCF of the AAM group was 89.4%, which was significantly higher than that in the BMV group (84.3%) (P< 0.01). Forty-one patients had ROSC at the time of arrival at the hospital, and the CCF of ROSC patients was 89.7%, which was significantly higher than that of non-ROSC patients (87.2%) (P< 0.01). ROSC was also obtained in 31.8% of the patients in the AAM group, which was significantly higher than that in the BMV group (12.2%).Conclusion: In this study, we found that advanced airway management during prehospital emergency transport by paramedics showed high CCF and ROSC rates and contributed to improving the prognosis of OHCA patients through high-quality resuscitation.Keywords: cardio pulmonary resuscitation, endotracheal intubation, supraglottic airways devices, outcome

Keywords

• cardio pulmonary resuscitation
• end-tracheal intubation
• supraglottic airways devices
• outcome.