#VisualAbstract: Endotracheal intubation offers no benefit over supraglottic airway in patients with out-of-hospital return of spontaneous circulation

1. Rates of sustained return of spontaneous circulation after non-traumatic out-of-hospital cardiac arrest in Taipei were similar between those who received prehospital supraglottic airway and those who received endotracheal intubation.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Advanced life support for out-of-hospital cardiac arrest (OHCA) includes critical airway management. Previous studies are conflicting on whether supraglottic airway (SGA) insertion or endotracheal intubation (ETI) is the best approach for advanced airway management for OHCA. The SAVE randomized controlled trial examined whether patient outcomes differed between SGA and ETI as the initial prehospital airway management for non-traumatic OHCA. Paramedics trained to perform both SGA and ETI were recruited from Taipei. Patients were randomized to receive either initial SGA insertion or initial ETI between November 11, 2016, and December 21, 2019. The primary outcome was a sustained return of spontaneous circulation (ROSC), defined as ROSC for greater than 2 hours after a cardiac arrest. Among potentially eligible patients, 968/7514 (13%) were enrolled, and outcomes were available for 936/968 (97%) of patients. First attempt success rates for ETI and SGA were 77% and 83%, respectively. Sustained ROSC did not significantly differ between the ETI cohort and the SGA cohort, respectively (139/517 [26.9%] vs. 108/419 (25.8%); odds ratio [OR]: 1.02 [95% CI: 0.98-1.06]). However, prehospital ROSC occurred more frequently in the ETI group compared to the SGA cohort (OR: 1.04 [95% CI: 1.02-1.07]). Sustained ROSC rates among ETI-treated patients compared to SGA-treated patients did not differ among all subgroups (shockable rhythm, public location, witnessed arrest, call to airway time of greater than or less than 14 minutes, or age greater than or less 77 years old). Prehospital ROSC was significantly more frequent among ETI-treated patients if they were not in a public location, had a witnessed arrest, or were 77 years or older. Overall, prehospital airway management of ETI versus SGA resulted in similar rates of sustained ROSC post-OHCA. This study was limited by the smaller sample size than initially expected and different-sized treatment groups.

Click to read the study in JAMA Network Open

Relevant Reading: The effect of successful intubation on patient outcomes after out-of-hospital cardiac arrest in Taipei

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