For patients with cardiac arrest outside the hospital, paramedics provide not only primary life support such as cardiopulmonary resuscitation such as chest compressions and electric shock using an AED (extracorporeal defibrillator), but also primary life support. If self-heartbeat does not resume after life-saving measures, perform secondary life-saving measures such as advanced airway management using an supraclavicular airway management device or a tracheal intubation tube, and administration of adrenaline from the venous route.However, the effectiveness of high airway management in out-of-hospital cardiac arrest has not been fully clarified so far.
This time, research groups such as Osaka University and the University of Pittsburgh evaluated the effect of high airway management in out-of-hospital cardiac arrest using a new analysis method, "time-dependent tendency score continuous matching analysis method," and used primary life-saving measures. Among patients whose self-heartbeat did not resume, those who could not adapt to electric shock had better survival after 1 month in the group with advanced airway management than in the group without it. I showed that.
In research using conventional propensity score matching analysis (a method of matching patients with similar scores by using background factors such as patient age and medical history as propensity scores), the altitude of emergency services in out-of-hospital cardiac arrest It was suggested that airway management was not effective.One of the causes of this result is the "resuscitation time bias" in which the group with a poor prognosis in which the self-heartbeat does not resume and the resuscitation action is prolonged is more likely to receive a high airway management.Therefore, the research group newly introduced a "time-dependent tendency score continuous matching analysis" that calculates a propensity score for each time when an advanced airway is secured and matches the group with and without an advanced airway at the same timing. ..As a result, it was found that the survival rate after 1 month of out-of-hospital cardiac arrest was significantly better when the high airway was secured.
The results of this study show the effectiveness of pre-hospital rescue by paramedics and are expected to influence the revision of international cardiopulmonary resuscitation guidelines.
Paper information:[British Medical Journal] Prehospital advanced airway management for adult patients with out-of-hospital cardiac arrest: a nationwide cohort study
