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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

Battaglini, Denise ; Schiavetti, Irene ; Ball, Lorenzo ; Jakobsen, Janus Christian ; Lilja, Gisela LU ; Friberg, Hans LU ; Wendel-Garcia, Pedro David ; Young, Paul J. ; Eastwood, Glenn and Chew, Michelle S. LU , et al. (2024) In Resuscitation 203.
Abstract

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... (More)

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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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Airway devices, Airway management, Cardiac arrest, Outcome, endotracheal intubation, Supraglottic device
in
Resuscitation
volume
203
article number
110390
publisher
Elsevier
external identifiers
  • pmid:39244144
  • scopus:85204111354
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2024.110390
language
English
LU publication?
yes
id
c978aec9-2255-4be2-ade0-710ebe24b2e3
date added to LUP
2024-11-22 09:41:35
date last changed
2025-07-05 18:16:24
@article{c978aec9-2255-4be2-ade0-710ebe24b2e3,
  abstract     = {{<p>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 &lt; 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.</p>}},
  author       = {{Battaglini, Denise and Schiavetti, Irene and Ball, Lorenzo and Jakobsen, Janus Christian and Lilja, Gisela and Friberg, Hans and Wendel-Garcia, Pedro David and Young, Paul J. and Eastwood, Glenn and Chew, Michelle S. and Unden, Johan and Thomas, Matthew and Joannidis, Michael and Nichol, Alistar and Lundin, Andreas and Hollenberg, Jacob and Hammond, Naomi and Saxena, Manoj and Martin, Annborn and Solar, Miroslav and Taccone, Fabio Silvio and Dankiewicz, Josef and Nielsen, Niklas and Morten Grejs, Anders and Wise, Matt P. and Hängghi, Matthias and Smid, Ondrej and Patroniti, Nicolò and Robba, Chiara}},
  issn         = {{0300-9572}},
  keywords     = {{Airway devices; Airway management; Cardiac arrest; Outcome, endotracheal intubation; Supraglottic device}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2024.110390}},
  doi          = {{10.1016/j.resuscitation.2024.110390}},
  volume       = {{203}},
  year         = {{2024}},
}