Comparison of outcomes between successful and failed prehospital advanced airway management by paramedic staff in patients with out-of-hospital cardiac arrest.
European journal of emergency medicine · 2025-04-01 · Registry study
Abstract
BACKGROUND AND IMPORTANCE: Although advanced airway management is beneficial for patients with out-of-hospital cardiac arrest (OHCA) in certain situations, the impact of advanced airway management success or failure by the emergency medical service (EMS) crew on the clinical time course and outcomes has not yet been thoroughly evaluated. OBJECTIVES: To evaluate the impact of EMS crew members' prehospital advanced airway management failure on patient outcomes in OHCA. DESIGN: Retrospective multicentre registry study. SETTING AND PARTICIPANTS: Data from an OHCA survey in a Japanese retrospective multicentre study conducted between 2019 and 2021 were reviewed. OUTCOME MEASURES AND ANALYSIS: Patients who underwent advanced airway management were divided into success and failure groups. The baseline characteristics and outcomes of the two groups were evaluated. Propensity score matching was performed by creating matched success and failure groups to analyse sensitivity. The primary outcome was 30-day survival, and secondary outcomes were favourable neurological outcomes at discharge, time from on-scene EMS arrival to hospital arrival, and return of spontaneous circulation (ROSC). MAIN RESULTS: Overall, 4474 patients who underwent prehospital advanced airway management were analysed. Among them, 4074 and 400 patients were in the success and failure groups, respectively. The 30-day survival rates (success vs. failure, 4.4 vs. 2.3%; P = 0.043) and ROSC (29.9 vs. 16.8%; P < 0.001) in the failure group were lower than those in the success group. There were no significant differences in survival rate at hospital discharge (3.6 vs. 2.0%; P = 0.093) and favourable neurological outcomes (1.3 vs. 1.3%; P = 0.930) between the groups. The median time from on-scene EMS arrival to hospital arrival (min) [28.0 (22.0-34.0) vs. 29.0 (25.9-35.0); P < 0.001] in the failure group was longer than that in the success group. After propensity score matching, the results showed a similar trend. CONCLUSION: Prehospital advanced airway management failure was associated with lower 30-day survival rates, ROSC, and a longer time between EMS arrival and hospital arrival. These findings suggest that failure of prehospital advanced airway management could potentially worsen the outcomes of patients with OHCA.