Prehospital intubation for out-of-hospital cardiac arrest

Introduction

The most appropriate advanced airway intervention in out-of-hospital cardiac arrest (OHCA) remains unproven. Trained ambulance personnel may attempt endotracheal intubation in the field for OHCA patients. This study aims to review prehospital airway management in OHCA.

Methods

Observational, retrospective case review over a 4-year period. All cases of OHCA brought to the Emergency Department of the Royal Infirmary of Edinburgh, Scotland were identified. Patient demographics, the airway management technique and documented complications were recorded. The primary endpoint measure was survival to hospital admission.

Results

In total, 794 OHCA cases were identified. The aetiology of cardiac arrest was medical in 95.2%, traumatic in 3.9% and unrecorded in 0.9% of cases. Prehospital endotracheal intubation was attempted in 628 (79%) cases and was successful in 573 (91.2%) cases. A significant complication (multiple attempts, displaced endotracheal tube or oesophageal intubation) occurred in 55 (8.8%) cases. In total, 165 (20.8%) patients survived to hospital admission, of whom 110 (17.5%) had undergone pre-hospital intubation. Fifty-five (33.1%) patients who did not undergo prehospital intubation survived to hospital admission.

Conclusion

Prehospital endotracheal intubation for out-of-hospital cardiac arrest is associated with significant complications. For ambulance crews not routinely undertaking endotracheal intubation, a supraglottic airway device may be more appropriate. Reliable methods of confirming endotracheal intubation in the field should be utilised.