Effect of prehospital advanced airway management on arterial blood gases in the pragmatic airway resuscitation trial

Effect of prehospital advanced airway management on arterial blood gases in the pragmatic airway resuscitation trial

Background: Advanced airway devices facilitate ventilation and oxygenation during out-of-hospital cardiac arrest (OHCA). Differences in gas exchange between advanced airway devices are unknown. Objective: Characterize arterial blood gases (ABG) in laryngeal tube (LT) or endotracheal intubation (ETI)...

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Main Authors: Grace C. Sullivan, Henry E. Wang, Christopher B. Gage, Jonathan R. Powell, Elisabete Aramendi, Xabier Jaureguibeitia, Andoni Elola, Ahamed Idris, Mohamud R. Daya, Shannon W. Stephens, Jestin N. Carlson, Graham Nichol, Tom P. Aufderheide, Ashish R. Panchal, Michelle M.J. Nassal
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Resuscitation Plus
Subjects:
Cardiac arrest
Ventilation
Advanced airway
Arterial blood gas
Online Access:http://www.sciencedirect.com/science/article/pii/S2666520425001559
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Summary:Background: Advanced airway devices facilitate ventilation and oxygenation during out-of-hospital cardiac arrest (OHCA). Differences in gas exchange between advanced airway devices are unknown. Objective: Characterize arterial blood gases (ABG) in laryngeal tube (LT) or endotracheal intubation (ETI) cases in the Pragmatic Airway Resuscitation Trial (PART). Methods: We included adult OHCAs with ABG collected ≤ 1.5 h after emergency department (ED) arrival. We collected 1) last prehospital airway technique used 2) ABG measurements (pH, PaO2, PaCO2), and 3) average prehospital end-tidal capnography (EtCO2) values for the last five minutes. We compared airway types, ABG values, and PaCO2-EtCO2 absolute difference (PaCO2-EtCO2) using the Mann-Whitney test, stratifying by circulation status. We also determined prehospital EtCO2 and ED PaCO2 correlation. Results: Of 3004 cases, 401 met inclusion with 272 LT and 129 ETI. Among cases achieving return of spontaneous circulation (ROSC), pH (7.1 vs. 7.2, p = 0.10) and PaO2 (142 vs 170 mmHg, p = 0.08) did not differ. PaCO2 was higher in LT than ETI (58 vs 50 mmHg, p = 0.003). Among cases without ROSC, pH (7.0 vs. 7.0, p = 0.55) and PaCO2 (64 vs. 61 mmHg, p = 0.58) did not differ, but PaO2 was lower in LT than ETI (85 vs. 123 mmHg, p = 0.03). EtCO2 did not correlate with PaCO2 in any airway device/ROSC combination. PaCO2-EtCO2 difference was wider in both LT and ETI non-ROSC cases compared to ROSC cases (27 vs 18 mmHg, p = 0.03). Conclusions: ABG values may vary by prehospital advanced airway management methods. The correlation between EtCO2 and PaCO2 in OHCA patients remains unclear.
ISSN:2666-5204

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