Prospects for the future of an airway management in patients with out-of-hospital cardiac arrest (OHCA): An overview of the existing data

Abstract

An overview of the existing data evaluating the overall effectiveness, safety, and feasibility of out-of-hospital endotracheal intubation (ETI) by paramedics/EMS (emergency medical service) was conducted. A specific focus was the question of whether the administration of ETI prior to hospital admittance improves the survival of patients with OHCA. The conclusions are as follows.
1) The provision of CPR with advanced airway management is a significant predictor of poor neurologically favorable survival compared to the use of conventional bag-valve-mask ventilation. Both ETI and the use of  supraglottic airway devices are associated with a decreased likelihood of favorable neurologic outcome.
2) EMS personnel have difficulty gaining and maintaining competency in ETI skills, and the administration of ETI by unskilled practitioners can result in adverse events. In addition, pre-hospital ETI influences patient  outcomes by affecting the execution of simultaneous basic life support procedures, resulting in ineffective chest compression with significant interruptions.
3) Personnel concerned with the Medical Control Affairs in Japan should discuss the need for strategies to improve airway management for individuals who have experienced an OHCA.