• Resuscitation · May 2014

    The Clinical Significance of a Failed Initial Intubation Attempt During Emergency Department Resuscitation of Out-of-Hospital Cardiac Arrest Patients.

    • Joonghee Kim, Kyuseok Kim, Taeyun Kim, Joong Eui Rhee, You Hwan Jo, Jae Hyuk Lee, Yu Jin Kim, Chan Jong Park, Hea-Jin Chung, and Seung Sik Hwang.
    • Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
    • Resuscitation. 2014 May 1;85(5):623-7.

    ObjectiveAdvanced airway management is one of the fundamental skills of advanced cardiac life support (ACLS). A failed initial intubation attempt (FIIA) is common and has shown to be associated with adverse events. We analysed the association between FIIA and the overall effectiveness of ACLS.MethodsUsing emergency department (ED) out-of-hospital cardiac arrest (OHCA) registry data from 2008 to 2012, non-traumatic ED-resuscitated adult OHCA patients on whom endotracheal intubation was initially tried were identified. Prehospital and demographic factors and patient outcomes were retrieved from the registry. The presence of a FIIA was determined by reviewing nurse-documented CPR records. The primary outcome was achieving a return of spontaneous circulation (ROSC). The secondary outcomes were time to ROSC and the ROSC rate during the first 30min of ED resuscitation.ResultsThe study population (n=512) was divided into two groups based on the presence of a FIIA (N=77). Both groups were comparable without significant differences in demographic or prehospital factors. In the FIIA group, the unadjusted and adjusted odds ratios (ORs) for achieving a ROSC were 0.50 (95% confidence interval [CI], 0.31-0.81) and 0.40 (95% CI, 0.23-0.71), respectively. Multivariable median regression analysis revealed that FIIA was associated with an average delay of 3min in the time to ROSC (3.08; 95% CI, 0.08-5.80). Competing risk regression analysis revealed a significantly slower ROSC rate during the first 15min (adjusted subhazard ratio, 0.52; 95% CI, 0.35-0.79) in the FIIA group.ConclusionFIIA is an independent risk factor for the decreased effectiveness of ACLS.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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