Time to invasive airway placement and resuscitation outcomes after inhospital cardiopulmonary arrest

Background: Clinicians often place high priority on invasive airway placement during cardiopulmonary resuscitation. The benefit of early vs. later invasive airway placement remains unknown. In this study we examined the association between time to invasive airway (TTIA) placement and patient outcomes after inhospital cardiopulmonary arrest (CPA).

Methods: We analyzed data from the National Registry of Cardiopulmonary Resuscitation (NRCPR). We included hospitalized adult patients receiving attempted invasive airway placement (endotracheal intubation, laryngeal mask airway, tracheostomy, and cricothyrotomy) after the onset of CPA. We excluded cases in which airway insertion was attempted after return of spontaneous circulation (ROSC). We defined TTIA as the elapsed time from CPA recognition to accomplishment of an invasive airway. The primary outcomes were ROSC, 24-h survival, and survival to hospital discharge. We used multivariable logistic regression to evaluate the association between the patient outcome and early (<5 min) vs. later (> or =5 min) TTIA, adjusted for hospital location, patient age and gender, first documented pulseless ECG rhythm, precipitating etiology and witnessed arrest.

Results: Of 82,649 CPA events, we studied the 25,006 cases in which TTIA was recorded and the inclusion criteria were met. Observations were most commonly excluded for not having an invasive airway emergently placed during resuscitation. The mean time to invasive airway placement was 5.9 min (95% CI: 5.8-6.0). Patient outcomes were: ROSC 50.3% (49.7-51.0%), 24-h survival 33.7% (33.1-34.3%), survival to discharge 15.3% (14.9-15.8%). Early TTIA was not associated with ROSC (adjusted OR: 0.96, 0.91-1.01) but was associated with better odds of 24-h survival (adjusted OR: 0.94, 0.89-0.99). The relationships between TTIA and survival to discharge could not be determined.

Conclusions: Early invasive airway insertion was not associated with ROSC but was associated with slightly improved 24-h survival. Early invasive airway management may or may not improve inhospital cardiopulmonary resuscitation outcomes.