Airway management in out of hospital cardiac arrest

Professor Jonathan Benger, University of the West of England and UHBristol

A cardiac arrest occurs when the heart and breathing stop suddenly, and is one of the most extreme medical emergencies. Outcomes are poor; 90% of patients die at the scene or before discharge from hospital. The best initial treatment is cardiopulmonary resuscitation (CPR), a combination of rescue breathing and chest compressions, but we do not know the best way for NHS ambulance staff to provide rescue breathing during an out of hospital cardiac arrest (OHCA). Until recently, placing a breathing tube in the windpipe (intubation) was considered the best method. However, attempting to place this breathing tube can cause significant complications. As a result, national recommendations have suggested using a newer and easier method: insertion of a supraglottic airway device (SAD). There is real uncertainty amongst paramedics and other experts in the field about the best method to ensure a clear airway during OHCA.

Professor Jonathan Benger secured funding from the National Institute for Health Research (NIHR) for a preliminary investigation to determine whether they could design a study to compare the two most promising SADs (the i-gel and LMAS) with current practice (usually tracheal intubation) during OHCA. This was done by dividing paramedics working in South Western Ambulance Service, and who agreed to take part, into three groups. One group was asked to use the i-gel, one group the LMAS and one group to continue as usual for each cardiac arrest they attended over the next 12 months. During the study they collected data about each patient attended by a participating paramedic.

Overall, the study worked better than expected. 184 paramedics agreed to take part, exceeding the target of 150. We also enrolled more patients than expected - 615 patients were attended by a participating paramedic and enrolled in the study. The outcomes from this feasibility study have provided valuable information that is essential for planning a full trial. Our team is now in an ideal position to carry out a full scale randomised trial in several UK ambulance services. This will answer the clinical question definitively, and guide future practice in the UK and overseas.

A dissemination event was held on 29/11/13 attended by researchers, other clinicians, paramedics involved in the study, and members of the REVIVE patient and public involvement group.

Further information: Dissemination event programme 29th November 2013: https://info.uwe.ac.uk/news/uwenews/news.aspx?id=2689