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Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients

Eujene Jung, Young Sun Ro, Hyun HoRyu, Sang Do Shin


Introduction: The optimal prehospital airway management technique for out-of-hospital cardiac arrest (OHCA) patients remains controversial. This study aimed to investigate the association between prehospital advanced airway management and survival outcomes based on transport time intervals (TTIs) using a nationwide OHCA registry database in Korea.

Background: OHCA is associated with high morbidity and low survival rates. Survival to discharge rates vary across different regions, with Asia having lower rates compared to Europe and North America. Limited treatments have been proven effective in improving survival outcomes for OHCA patients at the prehospital stage. Prehospital airway management techniques, including bag-valve mask (BVM), supraglottic airway (SGA), and endotracheal intubation (ETI), are essential components of bundle care for OHCA. However, studies have yielded contradictory results regarding the effectiveness of these techniques.

Methods: This study obtained ethical approval from the institutional review board, and informed consent was waived. The analysis included OHCA cases assessed by emergency medical services within a specified period. Demographic data and survival outcomes were evaluated.

Results: Among 117,730 EMS-assessed OHCA cases, 70,530 met the inclusion criteria. The study found that survival to discharge rates were higher in patients who received advanced airway management (ETI and SGA) compared to those who received BVM. The differences in outcomes were more prominent in patients with longer TTIs. However, the neurologically favorable survival to discharge in the SGA group was lower than that in the BVM group, while no significant difference was observed between the ETI and BVM groups.

Discussion: The study demonstrated that ETI and SGA were associated with higher survival to discharge rates compared to BVM in a Korean OHCA cohort. The effect of prehospital airway management on clinical outcomes was influenced by the transport time interval. These findings emphasize the importance of considering the expected TTI when selecting an airway management technique.

Conclusions: Based on this Korean population-based study, ETI and SGA were associated with significantly higher survival to discharge rates compared to BVM in OHCA patients. The transport time interval played a role in the impact of prehospital airway management on clinical outcomes. These results suggest that EMS providers should consider the expected TTI when choosing an airway management technique.

Citation: Jung E, Ro YS, Ryu HH, Shin SD (2022) Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients. PLoS ONE 17(6): e0269599.

Editor: Jignesh K. Patel, Stony Brook University Renaissance School of Medicine, UNITED STATES

Received: February 22, 2021; Accepted: May 24, 2022; Published: June 6, 2022

Copyright: © 2022 Jung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data cannot be shared publicly due to national OHCA registry restrictions. Researchers can obtain access to the data by contacting the Korea Centers for Disease Control and Prevention (CDC) via email: The data underlying the study results are available from Korea CDC.

Funding: This study received support from the Korea Centers for Disease Control and Prevention (CDC) and a grant (BCRI-20064) from Chonnam National University Hospital Biomedical Research Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors declare no competing interests.

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