Airway Strategy and Chest Compression Quality in the Pragmatic Airway Resuscitation Trial

BACKGROUND Chest compression (CC) quality is associated with improved out-of-hospital cardiopulmonary arrest (OHCA) outcomes. Airway management efforts may adversely influence CC quality. We sought to compare the effects of initial laryngeal tube (LT) and initial endotracheal intubation (ETI) airway management strategies upon chest compression fraction (CCF), rate and interruptions in the Pragmatic Airway Resuscitation Trial (PART).
METHODS We analyzed CPR process files collected from adult OHCA enrolled in PART. We used automated signal processing techniques and a graphical user interface to calculate CC quality measures and defined interruptions as pauses in chest compressions longer than 3seconds. We determined CC fraction, rate and interruptions (number and total duration) for the entire resuscitation and compared differences between LT and ETI using t-tests. We repeated the analysis stratified by time before, during and after airway insertion as well as by successive 3-minute time segments. We also compared CC quality between single vs. multiple airway insertion attempts, as well as between bag-valve-mask (BVM-only) vs. ETI or LT.
RESULTS Of 3,004 patients enrolled in PART, CPR process data were available for 1,996 (1,001 LT, 995 ETI). Mean CPR analysis duration were: LT 22.6±10.8min vs. ETI 25.3±11.3min (p<0.001). Mean CC fraction (LT 88% vs. ETI 87%, p=0.05) and rate (LT 114 vs. ETI 114 compressions per minute (cpm), p=0.59) were similar between LT and ETI. Median number of CC interruptions were: LT 11 vs. ETI 12 (p=0.001). Total CC interruption duration was lower for LT than ETI (LT 160 vs. ETI 181sec, p=0.002); this difference was larger before airway insertion (LT 56 vs. ETI 78sec, p<0.001). There were no differences in CC quality when stratified by 3-min time epochs.
CONCLUSION In the PART trial, compared with ETI, LT was associated with shorter total CC interruption duration but not other CC quality measures. CC quality may be associated with OHCA airway management.

as reported in: Resuscitation. 2021 Feb 11 [Epub ahead of print]