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EMS providers could save an additional 10,000 lives a year using newer breathing tube

Largest NIH study of its kind compared airway tubes used by EMS providers in 3,000 patients with sudden cardiac arrest nationwide, including Portland-metro area, Southwest Washington
Intubation
A new study reveals that sudden cardiac arrest patients who received a laryngeal tube as the initial airway had higher survival rate than those who had traditional endotracheal intubation. (Getty Images)

Nearly half a million people are treated for sudden cardiac arrest out of hospital each year, according to the American Heart Association, but only about 10 percent survive. That percentage improved significantly when emergency medical services providers used a newer breathing device to manage the airway in the field, a multi-center group of researchers report.

Their findings will be presented today at the 2018 Society for Academic Emergency Medicine in Indianapolis, Indiana.

“Our research revealed that sudden cardiac arrest patients who received the newer and easier to use laryngeal tube as the initial airway had higher survival rate than those individuals who were randomized to an initial strategy of traditional endotracheal intubation. Based on these results, we estimate that EMS providers could save an additional 10,000-plus lives a year,” said Mohamud Daya, M.D., M.S., co-principal investigator at OHSU and a professor of emergency medicine in the OHSU School of Medicine.

Called the Pragmatic Airway Resuscitation Trial, or PART, the study is the largest of its kind to test oxygen delivery methods used by firefighters, emergency medical technicians and paramedics around the country. Getting oxygen into the lungs is an important part of reviving a patient experiencing sudden cardiac arrest.

“While EMS providers have traditionally established airways using the same technique that’s used in hospitals, endotracheal intubation in the field can be extremely challenging and prone to errors,” said Matt Hansen, M.D., M.C.R., co-principal investigator at OHSU and an assistant professor of emergency medicine in the OHSU School of Medicine.

Mohamud Daya, M.D., M.S.
Mohamud Daya, M.D., M.S., co-principal investigator of the Pragmatic Airway Resuscitation Trial. Daya is a professor of emergency medicine in the OHSU School of Medicine. (OHSU/Kristyna Wentz-Graff)

To conduct the research, Daya, Hansen and colleagues in Birmingham, Dallas-Fort Worth and Milwaukee compared survival rates among 3,000 adults with sudden cardiac arrest treated by paramedic crews with 27 EMS agencies from December 2015 to November 2016.

Approximately half of study participants were managed initially with the newer laryngeal tube, a device inserted into the esophagus -- the opening to the throat and stomach where you swallow -- to block off the esophagus so that air only goes into lung, while the other half were initially managed with traditional endotracheal intubation -- a plastic breathing tube inserted into the trachea, or windpipe -- to guide air directly into the lungs. If the initial airway strategy failed, prehospital providers were permitted to use all available rescue strategies including the laryngeal tube and endotracheal tube.  

Both breathing tubes are approved by the FDA and not considered investigational devices but had not been compared to determine whether one works better than the other -- until now.

A total of 18.3 percent of participants in the laryngeal tube group survived three days in the hospital, while only 15.4 percent in the intubation group survived three days. A total of 10.8 percent of participating in the laryngeal tube group survived to hospital discharge compared to 8.1 percent in the intubation group. The proportion of participants surviving with good brain function was also higher in the laryngeal tube group.

“The newer laryngeal tubes were inserted more quickly and required fewer attempts,” Hansen explained. “Additional analysis is ongoing to gain further insight into the study findings.”

PART was conducted by the Resuscitation Outcomes Consortium, a group of investigators and EMS and hospital care providers nationwide who study early treatments for sudden cardiac arrest and severe injuries that cause disabilities and deaths. It was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

Study contributors

  • Portland Regional Coordinating Center
    • Mohamud Daya, M.D., site PI; Denise Griffiths; Matthew Hansen, M.D.; Michael Kampp; Nancy Le; Rahill Mirlohi; Jack Nuttall; Edgardo Peteros, Jr; Dana Zive.
  • Clackamas County Fire District 1
    • William Conway, EMS chief; Deidre Toczyski; Mike Verkest; Craig Warden, M.D.
  • Hillsboro Fire Department
    • Catherine Amerson; Amanda Pedroza; Anne Raven; Michael Shertz, M.D.
  • Lake Oswego Fire Department
    • Steven Dehart; Ritu Sahni, M.D.; Gert Zoutendijk. 
  • Metro West Ambulance
    • Larry Boxman; Matthew McCoy, M.D.; Ritu Sahni, M.D.; Shawn Wood
  • Skamania County EMS
    • Greg Hoskins, M.D.; Lynn Wittwer, M.D.; Brian Nichols
  • Tualatin Valley Fire & Rescue, Tigard
    • Dana Alteneder; Mohamud Daya, M.D.; David Dennis; Matthew Hansen, M.D.; William Steward; Scott Sullivan; Brent VanKeulen, EMS chief.
  • Legacy Meridian Park Hospital
    • Cameron Klug, M.D., hospital PI; Karla Kummer
  • Kaiser Sunnyside and Westside Hospitals
    • Christina Carlson; Ryan Radecki, M.D., hospital PI; Samantha Sahnow
  • PeaceHealth Southwest Medical Center, Vancouver, Washington
  • Providence Milwaukie Hospital, Milwaukie, Oregon
  • Providence Newberg Hospital, Newberg, Oregon
  • Providence St. Vincent Hospital, Portland, Oregon
  • Providence Willamette Falls Hospital, Oregon City, Oregon
  • OHSU-Tuality Community Hospital, Hillsboro, Oregon
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