• Denise Battaglini, Irene Schiavetti, Lorenzo Ball, Janus Christian Jakobsen, Gisela Lilja, Hans Friberg, Pedro David Wendel-Garcia, Paul J Young, Glenn Eastwood, Michelle S Chew, Johan Unden, Matthew Thomas, Michael Joannidis, Alistar Nichol, Andreas Lundin, Jacob Hollenberg, Naomi Hammond, Manoj Saxena, Annborn Martin, Miroslav Solar, Fabio Silvio Taccone, Josef Dankiewicz, Niklas Nielsen, Morten GrejsAndersADepartment of Intensive Care Medicine, Aarhus University Hospital, Denmark, Department of Clinical Medicine, Aarhus University, Denmark., Matt P Wise, Matthias Hängghi, Ondrej Smid, Nicolò Patroniti, Chiara Robba, and TTM2 trial investigators.
• Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy. Electronic address: battaglini.denise@gmail.com.
• Resuscitation. 2024 Oct 1; 203: 110390110390.

IntroductionAirway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients' outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality.MethodsSecondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes.ResultsOf the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88-1.28, p = 0.54.ConclusionsIn the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes.Trial Registration NumberNCT02908308.Copyright © 2024 Elsevier B.V. All rights reserved.

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