Video laryngoscopy for out of hospital cardiac arrest

Abstract

Introduction

Endotracheal intubation is an import component of out-of-hospital cardiac arrest (OHCA) resuscitation. In this analysis, we evaluate the association of video laryngoscopy (VL) with first pass success and return of spontaneous circulation (ROSC) using a national OHCA cohort.

Methods

We analyzed 2018 data from ESO Inc. (Austin, TX), a national prehospital electronic health record. We included all adult, non-traumatic cardiac arrests undergoing endotracheal intubation. We defined VL and direct laryngoscopy (DL) based on paramedic recorded intubation device. The primary outcomes were first pass success, ROSC, and sustained ROSC. Using multivariable, mixed models, we determined the association between VL and first pass success rate, ROSC, and sustained ROSC (survival to ED or ROSC in the field for greater than 20 min), fitting agency as a random intercept and adjusting for confounders.

Results

We included 22,132 patients cared for by 914 EMS agencies, including 5702 (25.7%) VL and 16,430 (74.2%) DL. Compared to DL, VL had a lower rate of bystander CPR, but other characteristics were similar between the groups. VL exhibited higher first pass success than DL (75.1% v 69.5%, p < .001). On mixed model analysis, VL was associated with a higher first pass success (OR 1.5, CI 1.3−1.6) but not ROSC (OR 1.1, CI 0.97–1.2) or sustained ROSC (OR 1.1, CI 0.9−1.2).

Conclusion

While associated with higher FPS, VL was not associated with increased rate of ROSC. The role of VL in OHCA remains unclear.

Introduction

Out of hospital cardiac arrest (OHCA) affects over 300,000 Americans every year,¹ with persistently low survival rates.² Resuscitation of these patients is an important area of study. The fundamentals of cardiac arrest care consist of providing rapid defibrillation when appropriate and both circulatory support in the form of chest compressions and ventilator support via bag valve mask, supraglottic airway, or endotracheal intubation. While electrical therapy and optimum chest compression technique has been thoroughly evaluated and is part of the AHA guidelines for OHCA care,³ there remains debate regarding the best strategy for ventilation.

Preventing hypoxia with proper ventilation is linked to improved survival after OHCA.⁴ While endotracheal intubation (ETI) is considered the definitive and most secure method of providing ventilation, ETI is also a difficult procedure that requires advanced training and regular practice to be succesful.⁵ First pass success (FPS) is often emphasized in resuscitation care, because each intubation failure increases the time to proper ventilation as well as number of chest compression interruptions.⁶

Video laryngoscopy (VL) utilizes a video camera to visualize airway anatomy during intubation, and some types of VL utilize hyper-acute angle blades which may provide better intubating conditions. Thus, VL potentially provides an easier, alternative method of intubation to direct laryngoscopy (DL).7, 8, 9, 10 While prior studies describe VL success,11, 12, 13, 14, 15, 16, 17 there are few studies evaluating the use of VL for OHCA intubation. In this study, we seek to determine the association of VL with intubation FPS and return of spontaneous circulation (ROSC) in adult OHCA.