Daorattanachai Kiattichai, Srivilaithon Winchana, Phakawan Vitchapon, Imsuwan Intanon
Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand.
Emerg Med Int. 2021 Dec 28;2021:2112629. doi: 10.1155/2021/2112629. eCollection 2021.
Sudden cardiac arrest is a critical condition in the emergency department (ED). Currently, there is no considerable evidence supporting the best time to complete advanced airway management (AAM) with endotracheal intubation in cardiac arrest patients presented with initial non-shockable cardiac rhythm.
To compare survival to hospital discharge and discharge with favorable neurological outcome between the ED cardiac arrest patients who have received AAM with endotracheal intubation within 2 minutes (early AAM group) and those over 2 minutes (late AAM group) after the start of chest compression in ED.
We conducted a retrospective cohort study involving the ED cardiac arrest patients who presented with initial non-shockable rhythm in ED. Multivariable logistic regression analysis was used to evaluate the independent effect of early AAM on outcomes. The outcomes included the survival to hospital discharge and discharge with favorable neurological outcome.
There were 416 eligible participants: 209 in the early AAM group and 207 participants in the late AAM group. The early AAM group showed higher survival to hospital discharge compared with the late AAM group, but no statistically significant difference (adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.59 -2.76, = 0.524). Discharge with favorable neurological outcome is also higher in the early AAM group (aOR: 1.68, 95% CI, 0.52 -5.45, = 0.387).
This study did not demonstrate a significant improvement of survival to hospital discharge and discharge with favorable neurological outcome in the ED cardiac arrest patients with initial non-shockable cardiac arrest who underwent early AAM within two minutes. More research is needed on the timing of AAM and on airway management strategies to improve survival.
心脏骤停是急诊科的危急情况。目前，尚无充分证据支持在初始心律不可电击复律的心脏骤停患者中，完成气管插管进行高级气道管理（AAM）的最佳时机。
比较急诊科心脏骤停患者在开始胸外按压后2分钟内接受气管插管进行AAM（早期AAM组）和2分钟后（晚期AAM组）的出院生存率及出院时神经功能良好的情况。
我们进行了一项回顾性队列研究，纳入了在急诊科初始心律不可电击复律的心脏骤停患者。采用多变量逻辑回归分析评估早期AAM对结局的独立影响。结局包括出院生存率及出院时神经功能良好。
共有416名符合条件的参与者：早期AAM组209名，晚期AAM组207名。早期AAM组的出院生存率高于晚期AAM组，但差异无统计学意义（调整优势比（aOR）：1.28，95%置信区间（CI）：0.59 - 2.76，P = 0.524）。早期AAM组出院时神经功能良好的比例也更高（aOR：1.68，95% CI，0.52 - 5.45，P = 0.387）。
本研究未表明在急诊科初始心律不可电击复律的心脏骤停患者中，早期（两分钟内）进行AAM能显著提高出院生存率及出院时神经功能良好的比例。需要对AAM的时机和气道管理策略进行更多研究以提高生存率。
