MedicalResearch.com Interview with:
Henry E. Wang, MD, MS
Professor and Vice Chair for Research
University of Texas Health Science Center at Houston
Department of Emergency Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: For over three decades, paramedics have performed endotracheal intubation (ETI) as the standard advanced airway management strategy in cardiac arrest. However, intubation is a difficult and error-prone intervention. Newer supraglottic airways such as the laryngeal tube (LT) offer easier insertion technique with comparable ventilation. However, intubation and laryngeal tubes have not been tested head-to-head in a randomized trial.
Our study – the Pragmatic Airway Resuscitation Trial (PART) – tested intubation vs laryngeal tube for airway management in adult out-of-hospital cardiac arrests. The trial included 27 EMS agencies from the Birmingham, Dallas-Fort Worth, Milwaukee, Portland and Pittsburgh communities. The trial randomized a total of 3,004 adult cardiac arrests to airway management with ETI or LT.
We found that compared with traditional ETI, LT was associated with almost 3% better survival. Out-of-hospital cardiac arrest survival in the US is less than 10%, so the observed difference is important.
MedicalResearch.com: What should readers take away from your report?
Response: Airway management in cardiac arrest is extremely difficult. Intubation is particularly difficult. When treating adult out-of-hospital cardiac arrests, we should give consideration to easier airway techniques such as the laryngeal tube.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We do not know if these results would apply to other communities or countries. We do not know the best airway management practices in children and adult victims of trauma. We also do not know the safety profile of the laryngeal tube and other newer airways. Also, we do not know if these finding apply to the inhospital setting.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study does not “spell the end of paramedic intubation.” Rather, this study highlights the difficulties of advanced airway management techniques such as intubation. EMS practitioners should recognize the challenges of airway management and ensure that they use techniques appropriate to their practice setting, patient population, and training resources.
Wang HE, Schmicker RH, Daya MR, et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial. JAMA. 2018;320(8):769–778. doi:10.1001/jama.2018.7044
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