Nakai-Uchida Mai, Uchida Masato, Tamura Shinobu, Kubo Atsushi, Kunitatsu Kosei, Nakashima Tsuyoshi, Horitani Ryosuke, Kajimoto Yoshinori, Inoue Shigeaki, Hironishi Masaya
Department of Internal Medicine & General Medicine, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan.
Department of General Internal Medicine, Hashimoto Municipal Hospital, 2-8-1 Ominedai, Hashimoto-shi, Wakayama, 648-0005, Japan.
BMC Emerg Med. 2025 Sep 24;25(1):185. doi: 10.1186/s12873-025-01341-6.
Patients with nonshockable out-of-hospital cardiac arrest (OHCA) have poor outcomes compared with those with shockable rhythm. The optimal strategy for advanced airway management (AAM) for these patients remains controversial. This study aimed to compare outcomes between prehospital endotracheal intubation (ETI) and supraglottic airway (SGA) for adults with witnessed and nonshockable OHCA.
We compared the outcomes according to airway management using a nationwide, population-based Japanese registry (All-Japan Utstein Registry) between 2005 and 2021. The study population included adults with witnessed, nontraumatic, nonshockable OHCA who received prehospital AAM by emergency medical service (EMS) personnel. The outcomes were return of spontaneous circulation (ROSC), 1-month overall survival, and 1-month survival with a favorable neurological outcome, defined as a Cerebral Performance Category score of 1 or 2. To adjust for confounding factors between the ETI and SGA groups, we used propensity score analysis with inverse probability of treatment weighting (IPTW) and performed a sensitivity analysis using overlap weighting.
A total of 147,088 patients were included: 30,797 (20.9%) received ETI and 116,291 (79.1%) received SGA. After IPTW adjustment, patients receiving ETI had significantly higher rates of ROSC (19.3% vs. 11.1%; odds ratio [OR] 1.51; 95% confidence interval [CI] 1.48-1.54), 1-month survival (6.4% vs. 4.5%, OR 1.44; 95%CI 1.40-1.49), and 1-month survival with favorable neurological outcomes (1.0% vs. 1.0%, OR 1.11; 95%CI 1.04-1.20) than those receiving SGA. The sensitivity analysis confirmed robust associations for ROSC (OR 1.53; 95%CI 1.45-1.61) and 1-month survival (OR 1.48; 95%CI 1.36-1.60), but the association with favorable neurological outcome was not statistically significant (OR 1.11; 95%CI 0.93-1.34).
In this Japanese nationwide Utstein registry cohort study with IPTW adjustment, for adult witnessed OHCA patients with initial nonshockable rhythm, prehospital ETI was associated with significantly higher rates of ROSC and 1-month survival, compared to prehospital SGA. These findings suggest that ETI, when performed by EMS personnel, has the potential to improve outcomes in these patients with OHCA.
与可电击心律的院外心脏骤停（OHCA）患者相比，不可电击心律的患者预后较差。这些患者高级气道管理（AAM）的最佳策略仍存在争议。本研究旨在比较成人目击且不可电击心律的OHCA患者在院前气管插管（ETI）和声门上气道（SGA）两种方式下的预后。
我们使用2005年至2021年全国性、基于人群的日本登记系统（全日本Utstein登记系统），根据气道管理方式比较了预后情况。研究人群包括成人目击、非创伤性、不可电击心律的OHCA患者，这些患者由紧急医疗服务（EMS）人员进行院前AAM。观察指标为自主循环恢复（ROSC）、1个月总生存率以及1个月时具有良好神经学预后的生存率，良好神经学预后定义为脑功能分类评分1或2。为了调整ETI组和SGA组之间的混杂因素，我们采用倾向评分分析和逆概率处理加权（IPTW），并使用重叠加权进行敏感性分析。
共纳入147,088例患者：30,797例（20.9%）接受ETI，116,291例（79.1%）接受SGA。经过IPTW调整后，接受ETI的患者ROSC发生率显著更高（19.3%对11.1%；优势比[OR]1.51；95%置信区间[CI]1.48 - 1.54）、1个月生存率更高（6.4%对4.5%，OR 1.44；95%CI 1.40 - 1.49），以及1个月时具有良好神经学预后的生存率更高（1.0%对1.0%，OR 1.11；95%CI 1.04 - 1.20）。敏感性分析证实了ROSC（OR 1.53；95%CI 1.45 - 1.61）和1个月生存率（OR 1.48；95%CI 1.36 - 1.60）之间存在稳健关联，但与良好神经学预后的关联无统计学意义（OR 1.11；95%CI 0.93 - 1.34）。
在这项经过IPTW调整的日本全国性Utstein登记队列研究中，对于成人目击且初始心律不可电击的OHCA患者，与院前SGA相比，院前ETI与显著更高的ROSC发生率和1个月生存率相关。这些发现表明，由EMS人员进行ETI有可能改善这些OHCA患者的预后。
