Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial
Background: Trans-nasal evaporative cooling is an effective method to induce intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest (OHCA). The use of supraglottic airway devices (SGA) instead of endotracheal intubation may enable shorter time intervals to induce cooling. We aimed to...
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| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/21/6370 |
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| author | Jonathan Tjerkaski Thomas Hermansson Emelie Dillenbeck Fabio Silvio Taccone Anatolij Truhlar Sune Forsberg Jacob Hollenberg Mattias Ringh Martin Jonsson Leif Svensson Per Nordberg |
| author_facet | Jonathan Tjerkaski Thomas Hermansson Emelie Dillenbeck Fabio Silvio Taccone Anatolij Truhlar Sune Forsberg Jacob Hollenberg Mattias Ringh Martin Jonsson Leif Svensson Per Nordberg |
| author_sort | Jonathan Tjerkaski |
| collection | DOAJ |
| description | Background: Trans-nasal evaporative cooling is an effective method to induce intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest (OHCA). The use of supraglottic airway devices (SGA) instead of endotracheal intubation may enable shorter time intervals to induce cooling. We aimed to study the outcomes in OHCA patients receiving endotracheal intubation (ETI) or a SGA during intra-arrest trans-nasal evaporative cooling. Methods: This is a pre-specified sub-study of the PRINCESS trial (NCT01400373) that included witnessed OHCA patients randomized during resuscitation to trans-nasal intra-arrest cooling vs. standard care followed by temperature control at 33 °C for 24 h. For this study, patients randomized to intra-arrest cooling were stratified according to the use of ETI vs. SGA prior to the induction of cooling. SGA was placed by paramedics in the first-tier ambulance or by physicians or anesthetic nurses in the second tier while ETI was performed only after the arrival of the second tier. Propensity score matching was used to adjust for differences at the baseline between the two groups. The primary outcome was survival with good neurological outcome, defined as cerebral performance category (CPC) 1–2 at 90 days. Secondary outcomes included time to place airway, overall survival at 90 days, survival with complete neurologic recovery (CPC 1) at 90 days and sustained return of spontaneous circulation (ROSC). Results: Of the 343 patients randomized to the intervention arm (median age 64 years, 24% were women), 328 received intra-arrest cooling and had data on the airway method (<i>n</i> = 259 with ETI vs. <i>n</i> = 69 with SGA). Median time from the arrival of the first-tier ambulance to successful airway management was 8 min for ETI performed by second tier and 4 min for SGA performed by the first or second tier (<i>p</i> = 0.001). No significant differences in the probability of good neurological outcome (OR 1.43, 95% CI 0.64–3.01), overall survival (OR 1.26, 95% CI 0.57–2.55), full neurological recovery (OR 1.17, 95% CI 0.52–2.73) or sustained ROSC (OR 0.88, 95% CI 0.50–1.52) were observed between ETI and SGA. Conclusions: Among the OHCA patients treated with trans-nasal evaporative intra-arrest cooling, the use of SGA was associated with a significantly shorter time to airway management and with similar outcomes compared to ETI. |
| first_indexed | 2024-03-09T18:58:11Z |
| format | Article |
| id | doaj.art-ed109da8e5e44233bcda20e1de056549 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T18:58:11Z |
| publishDate | 2022-10-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-ed109da8e5e44233bcda20e1de0565492023-11-24T05:16:36ZengMDPI AGJournal of Clinical Medicine2077-03832022-10-011121637010.3390/jcm11216370Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS TrialJonathan Tjerkaski0Thomas Hermansson1Emelie Dillenbeck2Fabio Silvio Taccone3Anatolij Truhlar4Sune Forsberg5Jacob Hollenberg6Mattias Ringh7Martin Jonsson8Leif Svensson9Per Nordberg10Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenDepartment of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1070 Brussels, BelgiumEmergency Medical Services of the Hradec Kralove Region, 500 05 Hradec Kralove, Czech RepublicDepartment of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenDepartment of Medicine, Karolinska Institute, 17176 Solna, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, SwedenBackground: Trans-nasal evaporative cooling is an effective method to induce intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest (OHCA). The use of supraglottic airway devices (SGA) instead of endotracheal intubation may enable shorter time intervals to induce cooling. We aimed to study the outcomes in OHCA patients receiving endotracheal intubation (ETI) or a SGA during intra-arrest trans-nasal evaporative cooling. Methods: This is a pre-specified sub-study of the PRINCESS trial (NCT01400373) that included witnessed OHCA patients randomized during resuscitation to trans-nasal intra-arrest cooling vs. standard care followed by temperature control at 33 °C for 24 h. For this study, patients randomized to intra-arrest cooling were stratified according to the use of ETI vs. SGA prior to the induction of cooling. SGA was placed by paramedics in the first-tier ambulance or by physicians or anesthetic nurses in the second tier while ETI was performed only after the arrival of the second tier. Propensity score matching was used to adjust for differences at the baseline between the two groups. The primary outcome was survival with good neurological outcome, defined as cerebral performance category (CPC) 1–2 at 90 days. Secondary outcomes included time to place airway, overall survival at 90 days, survival with complete neurologic recovery (CPC 1) at 90 days and sustained return of spontaneous circulation (ROSC). Results: Of the 343 patients randomized to the intervention arm (median age 64 years, 24% were women), 328 received intra-arrest cooling and had data on the airway method (<i>n</i> = 259 with ETI vs. <i>n</i> = 69 with SGA). Median time from the arrival of the first-tier ambulance to successful airway management was 8 min for ETI performed by second tier and 4 min for SGA performed by the first or second tier (<i>p</i> = 0.001). No significant differences in the probability of good neurological outcome (OR 1.43, 95% CI 0.64–3.01), overall survival (OR 1.26, 95% CI 0.57–2.55), full neurological recovery (OR 1.17, 95% CI 0.52–2.73) or sustained ROSC (OR 0.88, 95% CI 0.50–1.52) were observed between ETI and SGA. Conclusions: Among the OHCA patients treated with trans-nasal evaporative intra-arrest cooling, the use of SGA was associated with a significantly shorter time to airway management and with similar outcomes compared to ETI.https://www.mdpi.com/2077-0383/11/21/6370cardiac arrestintra-arrest hypothermiaairway management |
| spellingShingle | Jonathan Tjerkaski Thomas Hermansson Emelie Dillenbeck Fabio Silvio Taccone Anatolij Truhlar Sune Forsberg Jacob Hollenberg Mattias Ringh Martin Jonsson Leif Svensson Per Nordberg Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial Journal of Clinical Medicine cardiac arrest intra-arrest hypothermia airway management |
| title | Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial |
| title_full | Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial |
| title_fullStr | Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial |
| title_full_unstemmed | Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial |
| title_short | Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial |
| title_sort | strategies of advanced airway management in out of hospital cardiac arrest during intra arrest hypothermia insights from the princess trial |
| topic | cardiac arrest intra-arrest hypothermia airway management |
| url | https://www.mdpi.com/2077-0383/11/21/6370 |
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