Effect Of Different Airway Management Strategies On Prognosis Among In-Hospital Cardiac Arrest Patients

Background and Purpose:Airway management is an important part of cardiopulmonary resuscitation(CPR)for in-hospital cardiac arrest(IHCA).However,the relevant research has been very limited,and findings are conflicting.Thus,it is difficult to determine the best airway management strategy for IHCA patients based on existing studies Therefore,it is of great importance to explore the optimal strategy of airway management during CPR for IHCA.Methods:We conducted an observational retrospective cohort study in a tertiary general hospital in Shandong province.IHCA patients older than 18 years old who received chest compressions between July 2019 and June 2021 were enrolled.We collected patients’ clinical and demographic information as well as information on rescue treatment from medical records.Patients were divided into two groups according to the ventilation strategy they received.Patients who received bag-valve-mask(BVM)only were categorized into BVM group,patients who received endotracheal intubation after BVM ventilation were categorized into endotracheal intubation group.Patients who achieved restoration of spontaneous circulation(ROSC)for more than 20 minutes were then followed-up to obtain treatment outcomes,including surviving for more than 24 hours,30 days and the neurological outcome at 30 days.Binary logistic regression analysis was performed to identity the correlation between two different ventilation strategies and outcomes.Results:573 patients were included in the study.192(33.5%)patients received only bag-valve-mask(BVM)ventilation throughout the course of CPR.382(66.5%)patients received emergent endotracheal intubation after BVM ventilation throughout the course of CPR.Among all patients,199(34.7%)patients achieved ROSC for more than 20 minutes,97(16.9%)patients survived for more than 24 hours,21(3.7%)patients survived for more than 30 days,and 10(1.7%)patients had a favorable neurological outcome at 30 days after cardiac arrest with a CPC score of 1-2.There was a positive correlation between endotracheal intubation during resuscitation and ROSC for more than 20 minutes(OR:5.09,95%CI:3.138.28).There was also a positive correlation between endotracheal intubation and survival for 24h(OR:3.48,95%CI:1.91-6.37).Because the Hosmer-Lemeshow test showed a poor goodness of fit of the model,we cannot obtain the correlation between endotracheal intubation and survival for 30 days and favorable neurological outcome at 30 days.There was no correlation between the timing of intubation and ROSC for more than 20 minutes(OR:0.602,95%CI:0.354-1.023).Comparing to early intubation,delayed intubation is associated with worse prognosis of survival for more than 24 hours(OR:0.452,95%CI:0.246-0.832)or favorable neurological outcome at 30 days(OR:0.206,95%CI:0.048-0.877).Because the Hosmer-Lemeshow test showed a poor goodness of fit of the model,we cannot obtain the correlation between timing of intubation and survival for 30 days.Conclusion:Compared with BVM ventilation,using endotracheal intubation during resuscitation was associated with better sustained ROSC and survival at 24 hours and in adult IHCA patients.The long-term survival prognosis of IHCA patients is still poor.