• Vera Garcheva, Carolina Sanchez Martinez, John Adel, Tobias J Pfeffer, Muharrem Akin, Johann Bauersachs, and Andreas Schäfer.
• Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
• Resuscitation. 2024 Dec 1; 205: 110416110416.

BackgroundSupraglottic airway devices such as the laryngeal tube (LT) are recommended in current guidelines for simplified airway management in patients during and immediately after out-of-hospital cardiac arrest (OHCA). Trials evaluating LTs included predominantly OHCA patients with non-shockable rhythms and low survival rates. Hence, LTs are widely used, but their impact on preventing hypoxic brain damage during resuscitation has not been evaluated yet.MethodsWe analysed 452 OHCA-patients with shockable-rhythms from the HAnnover COoling REgistry (HACORE) who had return of spontaneous circulation prior to transport. Of those, 405 patients received primary airway management by endotracheal intubation (ETI) and 47 by LT. Patients were afterwards treated according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) applying a strict post-resuscitation management including therapeutic hypothermia and avoiding routine prognostication.ResultsWhile mortality in this group was moderate with both airway strategies (ETI 29 % vs LT 34 %, p = 0.487), the rate of anoxic brain damage was much higher in the LT compared to the ETI group (38 % vs 21 %, p = 0.011). Survivors in the ETI group were more likely to have good neurological outcome (cerebral performance category 1&2) compared to the LT group (35 % vs 17 %, p = 0.013). Pneumonia was more common in the LT vs ETI group (81 % vs 53 %, p < 0.001).ConclusionsWhile the original prehospital pragmatic trials comparing LT to ETI mostly included patients with non-shockable rhythm in settings with high mortality, our analysis is based on a real-world registry and focuses on successfully resuscitated patients, whose cause of arrest was most probably not due to hypoxia. In this cohort, use of LT was associated with a higher rate of anoxic brain damage and worse functional neurological outcome compared to use of ETI.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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