Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest
Aim: Guidelines recommend supraglottic airways (e.g. laryngeal tube, LT) for out-of-hospital cardiac arrest (OHCA) if providers are not skilled in endotracheal intubation (ETI). In prolonged cardiopulmonary resuscitation (CPR) LT led to asphyxial physiology. Therefore we evaluated the impact of LT v...
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Elsevier
2024-12-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520424002649 |
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| author | Olaf Aretz Jana Vienna Rödler Athina Gavriil Marc Deussen Emmanuel Chorianopoulos Sebastian Bergrath |
| author_facet | Olaf Aretz Jana Vienna Rödler Athina Gavriil Marc Deussen Emmanuel Chorianopoulos Sebastian Bergrath |
| author_sort | Olaf Aretz |
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| description | Aim: Guidelines recommend supraglottic airways (e.g. laryngeal tube, LT) for out-of-hospital cardiac arrest (OHCA) if providers are not skilled in endotracheal intubation (ETI). In prolonged cardiopulmonary resuscitation (CPR) LT led to asphyxial physiology. Therefore we evaluated the impact of LT vs. ETI on gasometry and lactate at admission. Methods: All patients from 1 January 2020 to 30 April 2023 with return of spontaneous circulation (ROSC) or ongoing CPR (no ROSC) were included in this retrospective cohort study.Continuous data were analysed using the Mann-Whitney-U-Test. Results: Overall, 147 patients were included: ETI, n = 104; LT, n = 33; other airways, n = 10. ROSC, n = 86; no ROSC, n = 61. ETI vs. LT (median) for all patients showed: arterial blood gas analyses (BGA) (n = 62 vs. n = 20): pH 7.01 vs. 7.07, p = 0.83; pCO2 64.5 vs. 66.6 mmHg, p = 0.62; lactate 10.1 vs. 9.5 mmol/l, p = 0.68. Venous BGA (n = 37 vs. n = 11): pH 6.91 vs. 7.12, p = 0.15; pCO2 77.4 vs. 66.0 mmHg, p = 0.19; lactate 11.5 vs. 8.6 mmol/l, p = 0.24. ROSC, arterial BGA (n = 39 vs. n = 12): pH 7.09 vs. 7.14, p = 0.36; pCO2 60.3 vs. 56.4 mmHg, p = 0.84; lactate 8.95 vs. 7.0 mmol/l, p = 0.35. No ROSC, arterial BGA (n = 23 vs. n = 8): pH 6.9 vs. 6.8, p = 0.03; pCO2 80.7 vs. 85.6 mmHg, p = 0.64; lactate 13.0 vs. 14.6 mmol/l, p = 0.62. Conclusion: The prehospital airway strategy had no impact on gasometry in this OHCA collective except a better pH with ETI in no ROSC. Due to small numbers and non-existent data about the exact prehospital ventilation parameters, further prospective studies are needed to evaluate this question. |
| format | Article |
| id | doaj-art-519ab749c51a40539dd46dfce8d90e5e |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-519ab749c51a40539dd46dfce8d90e5e2024-12-21T04:29:56ZengElsevierResuscitation Plus2666-52042024-12-0120100813Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrestOlaf Aretz0Jana Vienna Rödler1Athina Gavriil2Marc Deussen3Emmanuel Chorianopoulos4Sebastian Bergrath5Department of Clinical Acute and Emergency Medicine, Kliniken Maria Hilf Mönchengladbach, Academic Teaching Hospital of RWTH Aachen University, Germany; Chair of Anaesthesiology, Medical Faculty of RWTH Aachen University, GermanyDepartment of Clinical Acute and Emergency Medicine, Kliniken Maria Hilf Mönchengladbach, Academic Teaching Hospital of RWTH Aachen University, GermanyDepartment of Cardiology and Internal Intensive Care Medicine, Kliniken Maria Hilf Mönchengladbach, Academic Teaching Hospital of RWTH Aachen University, GermanyEmergency Medical Service and Fire Department of the City of Mönchengladbach, GermanyDepartment of Cardiology and Internal Intensive Care Medicine, Kliniken Maria Hilf Mönchengladbach, Academic Teaching Hospital of RWTH Aachen University, GermanyDepartment of Clinical Acute and Emergency Medicine, Kliniken Maria Hilf Mönchengladbach, Academic Teaching Hospital of RWTH Aachen University, Germany; Chair of Anaesthesiology, Medical Faculty of RWTH Aachen University, Germany; Corresponding author at: Department of Clinical Acute and Emergency Medicine, Kliniken Maria Hilf, Academic Teaching Hospital of RWTH Aachen University, Viersener Straße 450, 41063 Mönchengladbach, Germany.Aim: Guidelines recommend supraglottic airways (e.g. laryngeal tube, LT) for out-of-hospital cardiac arrest (OHCA) if providers are not skilled in endotracheal intubation (ETI). In prolonged cardiopulmonary resuscitation (CPR) LT led to asphyxial physiology. Therefore we evaluated the impact of LT vs. ETI on gasometry and lactate at admission. Methods: All patients from 1 January 2020 to 30 April 2023 with return of spontaneous circulation (ROSC) or ongoing CPR (no ROSC) were included in this retrospective cohort study.Continuous data were analysed using the Mann-Whitney-U-Test. Results: Overall, 147 patients were included: ETI, n = 104; LT, n = 33; other airways, n = 10. ROSC, n = 86; no ROSC, n = 61. ETI vs. LT (median) for all patients showed: arterial blood gas analyses (BGA) (n = 62 vs. n = 20): pH 7.01 vs. 7.07, p = 0.83; pCO2 64.5 vs. 66.6 mmHg, p = 0.62; lactate 10.1 vs. 9.5 mmol/l, p = 0.68. Venous BGA (n = 37 vs. n = 11): pH 6.91 vs. 7.12, p = 0.15; pCO2 77.4 vs. 66.0 mmHg, p = 0.19; lactate 11.5 vs. 8.6 mmol/l, p = 0.24. ROSC, arterial BGA (n = 39 vs. n = 12): pH 7.09 vs. 7.14, p = 0.36; pCO2 60.3 vs. 56.4 mmHg, p = 0.84; lactate 8.95 vs. 7.0 mmol/l, p = 0.35. No ROSC, arterial BGA (n = 23 vs. n = 8): pH 6.9 vs. 6.8, p = 0.03; pCO2 80.7 vs. 85.6 mmHg, p = 0.64; lactate 13.0 vs. 14.6 mmol/l, p = 0.62. Conclusion: The prehospital airway strategy had no impact on gasometry in this OHCA collective except a better pH with ETI in no ROSC. Due to small numbers and non-existent data about the exact prehospital ventilation parameters, further prospective studies are needed to evaluate this question.http://www.sciencedirect.com/science/article/pii/S2666520424002649Out-of-hospital cardiac arrestEndotracheal intubationLaryngeal tubeGasometryPhysiology |
| spellingShingle | Olaf Aretz Jana Vienna Rödler Athina Gavriil Marc Deussen Emmanuel Chorianopoulos Sebastian Bergrath Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest Resuscitation Plus Out-of-hospital cardiac arrest Endotracheal intubation Laryngeal tube Gasometry Physiology |
| title | Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest |
| title_full | Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest |
| title_fullStr | Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest |
| title_full_unstemmed | Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest |
| title_short | Impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out-of-hospital cardiac arrest |
| title_sort | impact of endotracheal intubation versus laryngeal tube on gasometry and lactate at emergency department admission after out of hospital cardiac arrest |
| topic | Out-of-hospital cardiac arrest Endotracheal intubation Laryngeal tube Gasometry Physiology |
| url | http://www.sciencedirect.com/science/article/pii/S2666520424002649 |
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