Out-of-hospital cardiac arrests: EMS crews could save 10K lives with updated equipment

Physicians estimate they’ll save 10,000 lives a year if sudden cardiac arrest patients are resuscitated with laryngeal tubes rather than conventional endotracheal intubation, according to a National Institutes of Health (NIH)-funded study published this month in the Journal of the American Medical Association.

Henry E. Wang, MD, was first author of the paper, which compared survival rates for 3,000 adults who’d suffered cardiac arrest in Alabama, Texas, Wisconsin, Pennsylvania and Oregon. Paramedic crews from 27 EMS agencies resuscitated about half the pool using a laryngeal tube, while the other half received endotracheal intubation.

Wang said intubation is the first line of defense in out-of-hospital cardiac arrests, since reviving patients in that way echoes how in-hospital physicians administer care. But, he said, it might not be the most foolproof option.

“While identical to techniques used by doctors in the hospital, intubation in these severe and stressful prehospital settings is very difficult and fraught with errors,” Wang said in a release.

Instead, Wang and his colleagues compared standard intubation to the use of laryngeal tubes. Patients who were resuscitated with the latter option saw a three-day survival rate of 18.3 percent and a 10.8 percent discharge rate; those who received esophageal intubation saw a 15.4 percent three-day rate and 8.1 percent discharge rate. Patients in the laryngeal group also left the hospital with better brain function than those in the esophageal group, Wang said.

Co-author George Sopko, MD, MPH, said this study was the largest of its kind to test oxygen delivery methods used among EMS crews, and the first to identify an intervention that could improve patient survival rates.

“During resuscitation, opening the airway and having proper access to it is a key factor for the survival of someone who goes into cardiac arrest outside of a hospital,” he said in the release. “But one of the burning questions in prehospital emergency care has been, ‘Which is the best airway device?’ This study demonstrated that just by managing the airway well in the early stage of resuscitation, we could save more than 10,000 lives every year.”