Abstracts for the 2016 NAEMSP Scientific Assembly

2016 Prehospital Emergency Care  
Advanced airways (e.g., endotracheal tubes, supraglottic airways) are frequently placed by Emergency Medical Services (EMS) in patients with out-of-hospital cardiac arrest (OHCA). However, the optimal timing of advanced airway placement during the sequence of resuscitation events is unknown. We hypothesized that earlier advanced airway placement would be associated with increased probability of return of spontaneous circulation (ROSC). Methods: This secondary analysis of ROC PRIMED study data
more » ... cluded adult, non-traumatic, OHCA patients with advanced airway placement by EMS prior to ROSC. Patients were excluded if EMS witnessed the arrest or arrest time was unknown. The primary exposure variable was time from EMS arrival to advanced airway placement. The outcome variable was ROSC. A Cox proportional hazards model was constructed to estimate the probability of ROSC as a function of the time to advanced airway placement using non-linear penalized splines. The Cox model was stratified by initial cardiac rhythm, accounted for resuscitation duration, and adjusted for Utstein variables including age, sex, bystander interventions, and EMS response time. Patients were right censored at time of hospital arrival or EMS termination of resuscitation. Results: A total of 7,547 OHCA patients were evaluated. Mean age was 67 years (standard deviation 15), 69% were male, 38% had an initial shockable rhythm, and 49% received bystander CPR. Median EMS response time was 6 minutes (interquartile range 4-7). Time from EMS arrival to advanced airway placement was 0-5 minutes (12%), 5-10 (36%), 10-15 (29%), 15-20 (14%), 20-25 (5%), 25-30 (2%), and >30 (2%). Median time from EMS arrival to ROSC was 19 minutes (interquartile range 14-25). Time to advanced airway placement was significantly associated with ROSC based on the Cox model. For initial shockable rhythms, the probability of ROSC was 59%, 55%, 51%,
doi:10.3109/10903127.2015.1094161 pmid:26727342 fatcat:yuihuv72evdhbg7vd7nksd7mmq