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

the TTM2-trial investigators

doi:10.1016/j.resuscitation.2024.110390

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

the TTM2-trial investigators

Institut for Klinisk Medicin - Bedøvelse og Operation, Intensiv

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

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 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.

Originalsprog	Engelsk
Artikelnummer	110390
Tidsskrift	Resuscitation
Vol/bind	203
ISSN	0300-9572
DOI	https://doi.org/10.1016/j.resuscitation.2024.110390
Status	Udgivet - okt. 2024

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10.1016/j.resuscitation.2024.110390

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@article{68018bf443c1412c816dbd26e41e8ccc,

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",

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{\textquoteright} 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.",

keywords = "Airway devices, Airway management, Cardiac arrest, Outcome, endotracheal intubation, Supraglottic device",

author = "Denise Battaglini and Irene Schiavetti and Lorenzo Ball and Jakobsen, {Janus Christian} and Gisela Lilja and Hans Friberg and Wendel-Garcia, {Pedro David} and Young, {Paul J.} and Glenn Eastwood and Chew, {Michelle S.} and Johan Unden and Matthew Thomas and Michael Joannidis and Alistar Nichol and Andreas Lundin and Jacob Hollenberg and Naomi Hammond and Manoj Saxena and Annborn Martin and Miroslav Solar and Taccone, {Fabio Silvio} and Josef Dankiewicz and Niklas Nielsen and {Morten Grejs}, Anders and Wise, {Matt P.} and Matthias H{\"a}ngghi and Ondrej Smid and Nicol{\`o} Patroniti and Chiara Robba and {the TTM2-trial investigators}",

note = "Publisher Copyright: {\textcopyright} 2024 Elsevier B.V.",

year = "2024",

month = oct,

doi = "10.1016/j.resuscitation.2024.110390",

language = "English",

volume = "203",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

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. / the TTM2-trial investigators.
I: Resuscitation, Bind 203, 110390, 10.2024.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients

T2 - A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial

AU - Battaglini, Denise

AU - Schiavetti, Irene

AU - Ball, Lorenzo

AU - Jakobsen, Janus Christian

AU - Lilja, Gisela

AU - Friberg, Hans

AU - Wendel-Garcia, Pedro David

AU - Young, Paul J.

AU - Eastwood, Glenn

AU - Chew, Michelle S.

AU - Unden, Johan

AU - Thomas, Matthew

AU - Joannidis, Michael

AU - Nichol, Alistar

AU - Lundin, Andreas

AU - Hollenberg, Jacob

AU - Hammond, Naomi

AU - Saxena, Manoj

AU - Martin, Annborn

AU - Solar, Miroslav

AU - Taccone, Fabio Silvio

AU - Dankiewicz, Josef

AU - Nielsen, Niklas

AU - Morten Grejs, Anders

AU - Wise, Matt P.

AU - Hängghi, Matthias

AU - Smid, Ondrej

AU - Patroniti, Nicolò

AU - Robba, Chiara

AU - the TTM2-trial investigators

PY - 2024/10

Y1 - 2024/10

N2 - 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.

AB - 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.

KW - Airway devices

KW - Airway management

KW - Cardiac arrest

KW - Outcome, endotracheal intubation

KW - Supraglottic device

UR - http://www.scopus.com/inward/record.url?scp=85204111354&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2024.110390

DO - 10.1016/j.resuscitation.2024.110390

M3 - Journal article

C2 - 39244144

AN - SCOPUS:85204111354

SN - 0300-9572

VL - 203

JO - Resuscitation

JF - Resuscitation

M1 - 110390

ER -

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

Abstract

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