[Influence of airway management on the return of spontaneous circulation in out-of-hospital cardiac arrest: secondary analysis of a prospective multidevice study].
Medizinische Klinik - Intensivmedizin und Notfallmedizin · 2026-02-18 · Observational study
Abstract
BACKGROUND: With an incidence of 64.9/100,000 inhabitants in Germany, out-of-hospital cardiac arrest is a frequent reason for emergency medical services (EMS) deployment. Advanced airway management is a key part of advanced life support (ALS), enabling adequate ventilation and continuous chest compressions. Video laryngoscopy (VL), which is increasingly being used, is expected to lead to better success rates and shorter interruptions in chest compressions during airway management. Thus, this article focuses on type of airway management and the devices used and how they relate to the likelihood of achieving return of spontaneous circulation (ROSC) and the resulting survival and neurological outcome. METHODS: Between January 2020 and June 2024, EMS personnel and emergency physicians received questionnaires on airway management of out-of-hospital resuscitations in which they were involved. The data were supplemented by emergency protocols and defibrillator recordings. The analysis was conducted descriptively and statistically at a significance level of α ≤ 0.05. RESULTS: A total of 301 questionnaires were assessed: 35% of patients who received endotracheal intubation (ETI) achieved ROSC compared with 21.1% with the use of a supraglottic airway device (SGA; p = 0.09). With the McGrath VL, the ROSC rate was 43.6%, compared to 33.3% with the C‑MAC (p = 0.24). Following 1-2 intubation attempts, ROSC was achieved in 33.8% of cases, and in 28.6% of cases after more than two attempts. The survival rate was 9.1% after ETI and 2.6% after SGA (p = 0.17). With VL, 10.9% of patients survived, 64.7% with a good neurological outcome (cerebral performance category [CPC] 1-2). With direct laryngoscopy, 6.1% survived, 57.1% with CPC 1-2 (p = 0.19/p = 0.73). CONCLUSION: The results show a potential advantage of video laryngoscopy for endotracheal intubation, whereby > 2 intubation attempts are associated with poorer outcomes. Significant effects on ROSC, survival or an improved neurological outcome were not observed. Larger studies are necessary to verify the results. Increased use of video laryngoscopy could be beneficial regardless of the user.
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Tags
Endotracheal intubation · Mortality & survival · Quality of life & function · Supraglottic airway · Video laryngoscopy
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