2019

Sho Komukai≪Biomedical Statistics≫, Tetsuhisa Kitamura ≪Environmental Medicine and Population Sciences≫ ECG rhythm and Airway Management Make All the Difference During A Heart Attack

2019-03-01
Journal: The BMJ

Japan-based study involving Osaka University finds valuable correlation between use of advanced airway management and ECG rhythms indicating need/non-need for defibrillation during out-of-hospital cardiac arrest

One-month survival following adult out-of-hospital cardiac arrest with or without advanced airway management,
in non-shockable patients

Osaka – In cardiac arrest, the speed and type of treatment can literally mean life or death in the immediate term, but can also affect health outcomes after successful resuscitation.

During out-of-hospital cardiac arrest (OHCA), effective treatment starts with cardiopulmonary resuscitation (CPR) and, if necessary, electric shock by a defibrillator. In performing the process, emergency medical service (EMS) personnel also provide oxygen and ventilation either by the bag–valve–mask method or via more invasive advanced airway management (AAM) techniques, such as tube insertion, to keep the airway open. The ventilation methods have pros and cons in the immediate and longer term.

A team including researchers from Osaka University sought to identify patterns in the ventilation method and 1-month outcome after survival. To do so, they used data from more than 300,000 OHCA cases in the large-scale All-Japan Utstein Registry of the Fire and Disaster Management Agency (of Japan). Key in their work was tracing the correlation of electrocardiographic (ECG) rhythm and ventilation method, and the outcomes these combinations yielded. They reported their findings in The BMJ.

While AAM has been proven effective at protecting the airway during cardiac arrest treatment, many studies found it led to worse outcomes after survival. Its use compared with bag–valve–mask is controversial. The researchers sought to shed light on the debate.

“We noted that outcomes differed based on patients’ first-documented ECG rhythm,” says study co-author Sho Komukai.“We found shockable patients did not have improved 1-month outcomes after AAM. However, non-shockable patients treated with AAM showed better outcomes.”

A shockable rhythm indicates receptivity to defibrillation, while a non-shockable rhythm is treated with only CPR, often accompanied by intravenous adrenaline. Favorable outcomes include recovering the

The findings were made possible by the researchers’ use of an advanced statistical technique called time-dependent propensity-score sequential-matching analysis. This method accounts for the timing of AAM administration, and offsets bias from patients undergoing longer resuscitation and receiving more interventions. The result was a more accurate portrait of AAM’s outcomes, and the positive connection with AAM in non-shockable patients.

“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,” explains Tetsuhisa Kitamura. “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.”

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The article, “Prehospital Advanced Airway Management for Adult Patients with Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study,” was published in The BMJ at DOI: https://doi.org/10.1136/bmj.l430.

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Article: Prehospital Advanced Airway Management for Adult Patients with Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study
Journal: The BMJ
DOI: 10.1136/bmj.l430
Authors: Junichi Izawa, Sho Komukai, Koichiro Gibo, Masashi Okubo, Kosuke Kiyohara, Chika Nishiyama, Takeyuki Kiguchi, Tasuku Matsuyama, Takashi Kawamura, Taku Iwami, Clifton W Callaway, Tetsuhisa Kitamura
Funding: Clinical Investigator’s Research Project at Osaka University Graduate School of Medicine; Ministry of Education, Culture, Sports, Science and Technology of Japan
Summary: Japan-based research examined a large-scale national registry of cardiac arrest cases to measure the effects of advanced airway management (AAM) on 1-month outcomes after patients survived. The deep statistical analysis found that patients not needing electrical defibrillation (based on ECG rhythm) and receiving AAM had better outcomes, such as hospital discharge. The results suggest ECG rhythm is a valuable indicator for deciding on whether to use AAM during cardiac arrest.

Primary Keyword: Medicine/Health
Additional Keywords: Cardiology, Critical Care/Emergency Medicine, Health Care Systems/Services, Pulmonary/Respiratory Medicine
Categories: Life Sciences, Medical