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The impact of airway management on quality of cardiopulmonary resuscitation : an observational study in patients during cardiac arrest
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Yeung, Joyce, Chilwan, Mehboob, Field, Richard A., Davies, Robin P., Smith, F. Gao (Fang Gao) and Perkins, Gavin D. (2014) The impact of airway management on quality of cardiopulmonary resuscitation : an observational study in patients during cardiac arrest. Resuscitation, Volume 85 (Number 7). pp. 898-904. doi:10.1016/j.resuscitation.2014.02.018 ISSN 0300-9572.
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Official URL: http://dx.doi.org/10.1016/j.resuscitation.2014.02....
Abstract
Background:
Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality.
Methods:
Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device.
Results:
One hundred patients were enrolled in the study (2008–2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8–19.4) vs LMA median 8.0 s (IQR 5.5–15.9), p = 0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n = 50) improved NFR from baseline median 0.24 IQR 0.17–0.40) to 0.15 to (IQR 0.09–0.28), p = 0.012; LMA (n = 25) from median 0.28 (IQR 0.23–0.40) to 0.13 (IQR 0.11– 0.19), p = 0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n = 25) (median 0.29 (IQR 0.18–0.59) vs median 0.26 (IQR 0.12–0.37), p = 0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups.
Conclusion:
The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes.
| Item Type: | Journal Article | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Resuscitation | ||||||||||
| Publisher: | Elsevier Ireland Ltd | ||||||||||
| ISSN: | 0300-9572 | ||||||||||
| Official Date: | July 2014 | ||||||||||
| Dates: |
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| Volume: | Volume 85 | ||||||||||
| Number: | Number 7 | ||||||||||
| Page Range: | pp. 898-904 | ||||||||||
| DOI: | 10.1016/j.resuscitation.2014.02.018 | ||||||||||
| Status: | Peer Reviewed | ||||||||||
| Publication Status: | Published | ||||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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