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Original Research

Open Access

Association between prehospital airway management methods and neurologic outcome in out-of-hospital cardiac arrest with respiratory cause: a nationwide retrospective observational study

  • Yeongho Choi1,2
  • Tae Han Kim2,3,4,*,
  • Ki Jeong Hong1,2
  • Kyoung Jun Song2,3,4
  • Sang Do Shin2,4

1Department of Emergency Medicine, Seoul National University Hospital, 03080 Seoul, Republic of Korea

2Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 110-744 Seoul, Republic of Korea

3Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 07061 Seoul, Republic of Korea

4Department of Emergency Medicine, Seoul National University College of Medicine, 03080 Seoul, Republic of Korea

DOI: 10.22514/sv.2021.249 Vol.18,Issue 4,July 2022 pp.34-40

Submitted: 26 August 2021 Accepted: 22 October 2021

Published: 08 July 2022

*Corresponding Author(s): Tae Han Kim E-mail:


Cardiac arrests are resulted by various aetiology including respiratory cause. Advanced airway placement is an important prehospital intervention for oxygenation and ventilation in respiratory cardiac arrest. We evaluated the association between of advanced airway method and neurologic outcome in arrest with respiratory cause. Adult witnessed non-traumatic OHCA (out-of-hospital cardiac arrest) treated by emergency medical service (EMS) providers in 2013–2017 were enrolled in a nationwide OHCA database. The association between airway management methods (endotracheal intubation (ETI), supraglottic airway (SGA) and bag valve mask (BVM)) and outcome were evaluated according to the presumed cause of cardiac arrest (cardiac, respiratory or others). The primary outcome was good neurological recovery at discharge. Multivariable logistic regression models with interaction analysis was conducted. Of 40,443 eligible OHCA patients, the cause of arrest of 90.0%, 7.5%, and 2.4% of patients were categorized as cardiac, respiratory and others, respectively. There were no statistically significant differences in the effect of the advanced airway type on good neurologic recovery in the total population (adjusted odds ratio (aOR) 0.96 (0.81–1.14) for ETI; 1.01 (95% confidence intervals (CI) 0.93–1.11) for BVM). However, ETI was associated with better neurologic recovery than SGA or BVM in OHCA in cardiac arrest with suspected respiratory cause (aOR 3.12 (95% CI 1.24–7.80) for ETI; 0.99 (95% CI 0.51–1.91) for BVM). Prehospital ETI was associated with good neurologic outcome when the cause of arrest was respiratory. ETI may be considered initially when a respiratory cause is suspected on the scene.


Out-of-hospital cardiac arrest; Emergency medical service; Advanced airway placement; Respiratory cause

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Yeongho Choi,Tae Han Kim,Ki Jeong Hong,Kyoung Jun Song,Sang Do Shin. Association between prehospital airway management methods and neurologic outcome in out-of-hospital cardiac arrest with respiratory cause: a nationwide retrospective observational study. Signa Vitae. 2022. 18(4);34-40.


[1] Moriwaki Y, Tahara Y, Kosuge T, Suzuki N. Etiology of out-of-hospital cardiac arrest diagnosed via detailed examinations including perimortem computed tomography. Journal of Emergencies, Trauma and Shock. 2013; 6: 87–94.

[2] Engdahl J, Holmberg M, Karlson BW, Luepker R, Herlitz J. The epidemiology of out-of-hospital ‘sudden’ cardiac arrest. Resuscitation. 2002; 52: 235–245.

[3] Safar P, Paradis N, Weil M. Asphyxial cardiac arrest. Cardiac arrest The science and practice of resuscitation medicine. 1996; 39: 702–726.

[4] Truhlář A, Deakin CD, Soar J, Khalifa GE, Alfonzo A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015; 95: 148–201.

[5] Richman PB, Nashed AH. The etiology of cardiac arrest in children and young adults: Special considerations for ED management. The American Journal of Emergency Medicine. 1999; 17: 264–270.

[6] Brierley JB. Experimental hypoxic brain damage. Journal of Clinical Pathology. 1977; 11: 181–187.

[7] Erecińska M, Silver IA. Tissue oxygen tension and brain sensitivity to hypoxia. Respiration Physiology. 2001; 128: 263–276.

[8] Ong MEH, Perkins GD, Cariou A. Out-of-hospital cardiac arrest: prehospital management. The Lancet. 2018; 391: 980–988.

[9] Alexander R, Hodgson P, Lomax D, Bullen C. A comparison of the laryngeal mask airway and Guedel airway, bag and facemask for manual ventilation following formal training. Anaesthesia. 1993; 48: 231–234.

[10] Kurola J, Harve H, Kettunen T, Laakso JP, Gorski J, Paakkonen H, et al. Airway management in cardiac arrest—comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training. Resuscitation. 2004; 61: 149–153.

[11] Andersen LW, Granfeldt A. Pragmatic Airway Management in out-of-Hospital Cardiac Arrest. The Journal of American Medical Association. 2018; 320: 761–763.

[12] Jabre P, Penaloza A, Pinero D, Duchateau FX, Borron SW, Javaudin F, et al. Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. The Journal of American Medical Association. 2018; 319: 779–787.

[13] Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, et al. 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. The Journal of American Medical Association. 2018; 320: 769–778.

[14] Wang HE, Benger JR. Endotracheal intubation during out‐of‐hospital cardiac arrest: New insights from recent clinical trials. Journal of the American College of Emergency Physicians Open. 2020; 1: 24–29.

[15] Ohashi-Fukuda N, Fukuda T, Yahagi N. Effect of Pre-Hospital Advanced Airway Management for out-of-Hospital Cardiac Arrest Caused by Respiratory Disease: a Propensity Score–Matched Study. Anaesthesia and Intensive Care. 2017; 45: 375–383.

[16] Ro YS, Shin SD, Song KJ, Lee EJ, Kim JY, Ahn KO, et al. A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea. Resuscitation. 2013; 84: 547–557.

[17] Kim YT, Shin SD, Hong SO, Ahn KO, Ro YS, Song KJ, et al. Effect of national implementation of utstein recommendation from the global resuscitation alliance on ten steps to improve outcomes from out-of-Hospital cardiac arrest: a ten-year observational study in Korea. BMJ Open. 2017; 7: e016925.

[18] Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Aus-tralian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation. 2015; 132: 1286–1300.

[19] Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, et al. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation during out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. The Journal of American Medical Association. 2018; 320: 779–791.

[20] Izawa J, Komukai S, Gibo K, Okubo M, Kiyohara K, Nishiyama C, et al. Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: Nationwide cohort study. British Medical Journal. 2019; 364: l430.

[21] Kim TH, Hong KJ, Shin SD, Lee JC, Choi DS, Chang I, et al. Effect of endotracheal intubation and supraglottic airway device placement during cardiopulmonary resuscitation on carotid blood flow over resuscitation time: an experimental porcine cardiac arrest study. Resuscitation. 2019; 139: 269–274.

[22] Segal N, Yannopoulos D, Mahoney BD, Frascone RJ, Matsuura T, Cowles CG, et al. Impairment of carotid artery blood flow by supraglottic airway use in a swine model of cardiac arrest. Resuscitation. 2012; 83: 1025–1030.

[23] Baker PA, Webber JB. Failure to Ventilate with Supraglottic Airways after Drowning. Anaesthesia and Intensive Care. 2011; 39: 675–677.

[24] Fukuda T, Fukuda-Ohashi N, Doi K, Matsubara T, Yahagi N. Effective Pre-hospital Care for out-of-hospital Cardiac Arrest Caused by Respira-tory Disease. Heart, Lung and Circulation. 2015; 24: 241–249.

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