Benger JR, et al. - In adults with nontraumatic out-of-hospital cardiac arrest, experts explored whether a supraglottic airway device (SGA) is better than tracheal intubation (TI) as the initial advanced airway management strategy. In this study, use of a supraglottic airway device compared with tracheal intubation did not result in a favorable functional outcome at 30 days among patients with out-of-hospital cardiac arrest.

Methods

• This was a multicenter, cluster randomized clinical trial involving paramedics from four ambulance services in England responding to emergencies for approximately 21 million individuals.
• For this investigation, study participants aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018.
• Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced airway management strategy.
• Modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner was the primary outcome.
• Modified Rankin Scale score was divided into two ranges:
• 0-3 (good outcome) or
• 4-6 (poor outcome; 6 = death).
• Ventilation success, regurgitation, and aspiration were the included secondary outcomes.

Results

• An aggregate of 9,296 subjects (4,886 in the SGA group and 4,410 in the TI group) were selected (median age, 73 years; 3,373 were women [36.3%]), and the modified Rankin Scale score was known for 9,289 patients.
• In the SGA group, 311 of 4,882 subjects (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) compared to 300 of 4,407 patients (6.8%) in the TI group (adjusted risk difference [RD], -0.6% [95% CI, -1.6% to 0.4%]).
• Compared with 3,473 of 4,397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]), initial ventilation was successful in 4,255 of 4,868 patients (87.4%) in the SGA group.
• The findings suggested that patients randomized to receive TI were less likely to receive advanced airway management (3,419 of 4,404 patients [77.6%] vs 4,161 of 4,883 patients [85.2%] in the SGA group).
• It was observed that two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1,268 of 4,865 patients [26.1%] in the SGA group vs 1,072 of 4,372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, -0.6% to 3.4%]; aspiration: 729 of 4,824 patients [15.1%] vs 647 of 4,337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, -1.5% to 1.8%]).