Airway Management Correlates with Heart Attack Survival

A new study shows that advanced airway management (AAM) techniques are associated with better survival among out-of-hospital cardiac arrest (OHCA) patients with non-shockable heart rhythms.

Researchers at Osaka University (Japan), Jikei University School of Medicine (Tokyo, Japan), Otsuma Women’s University (Tokyo, Japan), and other institutions conducted a study involving 310,620 consecutive OHCA patients, who were divided into two sub-cohorts by first documented electrocardiograph (EEG): either shockable (ventricular fibrillation or pulseless ventricular tachycardia) or non-shockable (pulseless electrical activity or asystole) rhythms. The objective was to determine one-month survival rates, as associated with AAM.

In all, 41.2% of patients in the shockable cohort and 42% in the non-shockable cohort received AAM during cardiopulmonary resuscitation (CPR) following OHCA. The researchers found that in the shockable cohort, survival did not differ between patients with AAM (19.2%) and those with no AAM (18.6%). But in the non-shockable cohort, patients who received AAM (2.3%) had better survival than those who did not receive AAM (1.8%). The study was published on February 28, 2019, in BMJ.

“International guidelines do account for treatment based on ECG rhythms, yet we found that different airway management strategies based on these rhythms deserve greater attention,” said senior author Tetsuhisa Kitamura, MD, of Osaka University. “Shockable rhythm should receive immediate defibrillation and continuous chest-compression, rather than ventilatory support. However, non-shockable rhythm could benefit from oxygen delivery with AAM.”

Basic life support, which consists of early CPR and defibrillation with automated external defibrillators, improves outcomes in patients with OHCA. Providing oxygen to the lungs via bag-valve-mask ventilation and AMM, which secures better protection for the airway than bag-valve-mask ventilation alone, are also important resuscitation skills. A shockable ECG rhythm indicates receptivity to defibrillation, while a non-shockable rhythm is treated with only CPR, often accompanied by intravenous adrenaline.

Related Links:
Osaka University
Jikei University School of Medicine
Otsuma Women’s University