Bartos Jason A, Clare Agdamag Arianne, Kalra Rajat, Nutting Lindsay, Frascone R J, Burnett Aaron, Vuljaj Nik, Lick Charles, Tanghe Peter, Quinn Ryan, Simpson Nicholas, Peterson Bjorn, Haley Kari, Sipprell Kevin, Yannopoulos Demetris
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
Resuscitation. 2023 May;186:109769. doi: 10.1016/j.resuscitation.2023.109769. Epub 2023 Mar 17.
Multiple randomized clinical trials have compared specific airway management strategies during ACLS with conflicting results. However, patients with refractory cardiac arrest died in almost all cases without the availability of extracorporeal cardiopulmonary resuscitation (ECPR). Our aim was to determine if endotracheal intubation (ETI) was associated with improved outcomes compared to supraglottic airways (SGA) in patients with refractory cardiac arrest presenting for ECPR.
We retrospectively studied 420 consecutive adult patients with refractory out-of-hospital cardiac arrest due to shockable presenting rhythms presenting to the University of Minnesota ECPR program. We compared outcomes between patients receiving ETI (n = 179) and SGA (n = 204). The primary outcome was the pre-cannulation arterial PaO upon arrival to the ECMO cannulation center. Secondary outcomes included neurologically favorable survival to hospital discharge and eligibility for VA-ECMO based upon resuscitation continuation criteria applied upon arrival to the ECMO cannulation center.
Patients receiving ETI had significantly higher median PaO (71 vs. 58 mmHg, p = 0.001), lower median PaCO (55 vs. 75 mmHg, p < 0.001), and higher median pH (7.03 vs. 6.93, p < 0.001) compared to those receiving SGA. Patients receiving ETI were also significantly more likely to meet VA-ECMO eligibility criteria (85% vs. 74%, p = 0.008). Of patients eligible for VA-ECMO, patients receiving ETI had significantly higher neurologically favorable survival compared to SGA (42% vs. 29%, p = 0.02).
ETI was associated with improved oxygenation and ventilation after prolonged CPR. This resulted in increased rate of candidacy for ECPR and increased neurologically favorable survival to discharge with ETI compared to SGA.
多项随机临床试验比较了心肺复苏期间特定气道管理策略，结果相互矛盾。然而，几乎所有难治性心脏骤停患者在无法进行体外心肺复苏（ECPR）的情况下都会死亡。我们的目的是确定在接受ECPR的难治性心脏骤停患者中，与声门上气道（SGA）相比，气管插管（ETI）是否与更好的预后相关。
我们回顾性研究了明尼苏达大学ECPR项目中420例因可电击心律导致的难治性院外心脏骤停的成年连续患者。我们比较了接受ETI（n = 179）和SGA（n = 204）患者的预后。主要结局是到达体外膜肺氧合（ECMO）插管中心时插管前动脉血氧分压（PaO）。次要结局包括出院时神经功能良好的生存率，以及根据到达ECMO插管中心时应用的复苏持续标准确定的VA-ECMO资格。
与接受SGA的患者相比，接受ETI的患者的中位数PaO显著更高（71对58 mmHg，p = 0.001），中位数二氧化碳分压（PaCO）更低（55对75 mmHg，p < 0.001），中位数pH更高（7.03对6.93，p < 0.001）。接受ETI的患者也显著更有可能符合VA-ECMO资格标准（85%对74%，p = 0.008）。在符合VA-ECMO资格的患者中，接受ETI的患者神经功能良好的生存率显著高于SGA（42%对29%，p = 0.02）。
长时间心肺复苏后，ETI与改善氧合和通气相关。这导致ECPR候选率增加，与SGA相比，接受ETI的患者出院时神经功能良好的生存率增加。
