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September 11, 2018
Device improves survival after sudden cardiac arrest
At a Glance
- A device for supplying oxygen after sudden cardiac arrest outside of a hospital improved survival compared with a more invasive procedure.
- Switching to the easier-to-use device may help emergency medical personnel save more lives.
Sudden cardiac arrest is usually deadly. Less than 10% of people survive when their heart suddenly stops beating outside of a hospital. Sudden cardiac arrest outside of a hospital is initially handled by emergency medical services (EMS) personnel, such as paramedics or firefighters.
The resuscitation procedure after sudden cardiac arrest is complicated. It includes getting oxygen into the body and attempting to restart the heart. The typical way to supply oxygen has been through endotracheal intubation, which involves inserting a tube in the windpipe to keep the airway open. This procedure is regularly used in hospitals. However, it is difficult to perform in other settings, such as in a home or on the street.
Alternative devices have been developed that are faster, simpler, and require less training to use than endotracheal intubation. However, clinical trials haven’t directly compared the approaches. To get a better understanding of how well one such device works, researchers led by Dr. Henry Wang from the University of Texas compared endotracheal intubation with a breathing device called a laryngeal tube. The trial was funded by NIH’s Heart, Lung, and Blood Institute (NHLBI).
Over a two-year period, EMS teams in five U.S. cities were randomly assigned to either only perform endotracheal intubation or only use the laryngeal tube when responding to a sudden cardiac arrest. The teams were switched back and forth between the two assignments during the study to account for any potential differences. The odds of survival after 72 hours were compared between the two groups. Results were published on August 28, 2018, in the Journal of the American Medical Association.
A total of 3,000 people were included in the analysis. Survival after 72 hours was higher for people who received the laryngeal tube after their cardiac arrest than for those who received endotracheal intubation (18.3% vs. 15.4%). The laryngeal tube was also easier to use. EMS personnel successfully placed them in 90.3% of attempts. By contrast, only 51.6% of endotracheal intubations were completed successfully. (The EMS teams could switch to another technique if the initial one failed.)
People who received the laryngeal tube were more likely to have their heart start again before they reached the hospital (27.9% vs. 24.3%). They also had less risk of serious brain damage.
“Based upon these results, use of the newer, more flexible laryngeal breathing tube could result in thousands of saved lives every year,” Wang says.
More questions about the best ways to resuscitate these patients remain to be answered. These include how other available devices would compare with the ones tested in this study.
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References: Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. JAMA. 2018 Aug 28;320(8):769-778. doi: 10.1001/jama.2018.7044. PMID: 30167699.
Funding: NIH’s National Heart, Lung, and Blood Institute.