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Friday, November 19, 2010

The healing has begun

It's all about not interrupting chest compressions.


Prehospital Intubation Results in Worse Outcomes in Adult Cardiac Arrest Patients

Prehospital intubation was negatively associated with return of spontaneous circulation and survival to discharge.

Although studies in children suggest worse outcomes among those managed with prehospital intubation versus bag-valve-mask ventilation (JW Emerg Med Apr 1 2000), few studies have addressed this issue in adult patients with out-of-hospital cardiac arrest. In a retrospective study of data from an emergency medical services system in North Carolina for 1142 adult patients with cardiac arrest, researchers assessed the association between performance of prehospital endotracheal intubation and return of spontaneous circulation (ROSC) in the field and survival to discharge. The decision to attempt intubation was at the paramedics' discretion.

Intubation was not performed in 203 patients. In analysis that controlled for initial arrest rhythm, patients who were managed without any attempt at prehospital intubation were 2.3 times more likely to have ROSC in the field and 5.5 times more likely to be discharged from the hospital alive than patients who had one successful prehospital intubation attempt.

Comment: The 2010 American College of Cardiology/American Heart Association Advanced Cardiac Life Support guidelines emphasize chest compressions before airway management for all patients with cardiac arrest except newborns. Although these retrospective results could not determine cause and effect, the findings suggest that attempts at prehospital intubation are associated with worse outcomes in patients with out-of-hospital cardiac arrest. Interruption of chest compressions might contribute to the worse outcomes. Further study is warranted to determine whether prehospital intubation might cause more harm than good in adult patients with cardiac arrest.

Diane M. Birnbaumer, MD, FACEP

Published in Journal Watch Emergency Medicine November 19, 2010


Studnek JR et al. The association between prehospital endotracheal intubation attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients. Acad Emerg Med 2010 Sep; 17:918.