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Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients: A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial
D. Battaglini, I. Schiavetti, L. Ball, JC. Jakobsen, G. Lilja, H. Friberg, PD. Wendel-Garcia, PJ. Young, G. Eastwood, MS. Chew, J. Unden, M. Thomas, M. Joannidis, A. Nichol, A. Lundin, J. Hollenberg, N. Hammond, M. Saxena, A. Martin, M. Solar,...
Jazyk angličtina Země Irsko
Typ dokumentu časopisecké články, randomizované kontrolované studie, multicentrická studie
- MeSH
- intratracheální intubace * metody MeSH
- kardiopulmonální resuscitace * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- terapeutická hypotermie metody MeSH
- urgentní zdravotnické služby * metody MeSH
- zajištění dýchacích cest * metody MeSH
- zástava srdce mimo nemocnici * terapie mortalita MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients' outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality. METHODS: Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes. RESULTS: Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88-1.28, p = 0.54. CONCLUSIONS: In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes. TRIAL REGISTRATION NUMBER: NCT02908308.
Adult Critical Care University Hospital of Wales Cardiff UK
Anesthesia and Intensive Care IRCCS Ospedale Policlinico San Martino Genova Italy
Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Australia
Department of Clinical Medicine Anaesthesiology and Intensive Care Lund University Lund Sweden
Department of Clinical Sciences Lund Anesthesia and Intensive Care Lund University Lund Sweden
Department of Clinical Sciences Malmö Lund University Malmö Sweden
Department of Critical Care University of Melbourne Parkville VIC Australia
Department of Health Sciences University of Genoa Genova Italy
Department of Intensive Care Austin Hospital Heidelberg Australia
Department of Operation and Intensive Care Lund University Hallands Hospital Halmstad Halland Sweden
Department of Surgical Science and Integrated Diagnostics University of Genoa Genova Italy
Intensive Care Unit Wellington Regional Hospital Wellington New Zealand
Medical Research Institute of New Zealand Private Bag 7902 Wellington 6242 New Zealand
University Hospitals Bristol NHS Foundation Trust Bristol UK
Citace poskytuje Crossref.org
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- $a Battaglini, Denise $u Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy. Electronic address: battaglini.denise@gmail.com
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- $a Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients: A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial / $c D. Battaglini, I. Schiavetti, L. Ball, JC. Jakobsen, G. Lilja, H. Friberg, PD. Wendel-Garcia, PJ. Young, G. Eastwood, MS. Chew, J. Unden, M. Thomas, M. Joannidis, A. Nichol, A. Lundin, J. Hollenberg, N. Hammond, M. Saxena, A. Martin, M. Solar, FS. Taccone, J. Dankiewicz, N. Nielsen, A. Morten Grejs, MP. Wise, M. Hängghi, O. Smid, N. Patroniti, C. Robba, TTM2 trial investigators
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- $a INTRODUCTION: Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients' outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality. METHODS: Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes. RESULTS: Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88-1.28, p = 0.54. CONCLUSIONS: In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes. TRIAL REGISTRATION NUMBER: NCT02908308.
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