EMS World

NOV 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 19 of 51

Hospital Licensing EMSWORLD.com | NOVEMBER 2018 19 were also some limitations to the number of patients they could enroll, due primarily to limited funding. The authors also noted they could not assess the influence of chest compressions or ventilation quality. They also stated that many aspects of the study were not blinded, meaning bias could have been introduced. As always, I hope you can read the manu- script. There are a lot of informative figures and tables as well as a post-hoc analysis we were unable to review. ABOUT THE AUTHOR Antonio R. Fernandez, PhD, NRP, FAHA, is research director at the EMS Performance Improvement Center and an assistant professor in the Department of Emergency Medicine at the University of North CarolinaÐChapel Hill. in the initial LT group and 1,499 in the initial ETI group. Among the LT group the authors found 95% protocol compliance. In other words, 95% utilized LT (or BVM) for their initial attempt. The ETI group had 90.7% compliance. With respect to the study's main outcome of interest, 72-hour survival was higher in the LT group than the ETI group in the intent-to-treat analysis, and the result was statistically signifi- cant (18.3% vs. 15.4%, p=0.04). This result was similar in the per-protocol analysis (18.3% vs. 15.4%, p=0.045). In the as-treated analysis, LT seemed to perform better compared to ETI; how- ever, the finding was not statistically significant (16.0% vs. 13.5%, p=0.07). The LT group also performed better when evaluating the time from EMS arrival to starting airway management (median 9.8 minutes vs. 12.5 minutes), initial success (90.3% vs. 51.6%), and overall success (94.2% vs. 91.5%). P-values were not reported for time to airway management, ini- tial success, or overall success. There were 352 patients who received BVM only. When evaluating the secondary outcomes, the LT group had a higher percentage of ROSC (27.9% vs. 24.3%, p=0.03), hospital survival (10.8% vs. 8.1%, p=0.01), and favorable neuro- logical discharge (7.1% vs. 5.0%, p=0.02). The results show that LT performed better than ETI in every measure reported in this study. We often discuss the difference between clini- cal importance and statistical significance. The difference in the main outcome of interest here was about 3%, and it was statistically significant. Now, in some studies a 3% difference may not be clinically important. However, in this study we're talking about 72-hour survival post-OHCA. "Small" improvements in survival are huge wins! This is a case where the result is not only statisti- cally significant but clinically important as well. It is important to note that the main analysis, intent to treat, dictates that the conclusion has to be that an LT-based strategy of advanced airway management is effective. Limitations One limitation to this study is its type. A prag- matic study attempts to evaluate interventions in real-world conditions. Therefore, this study did not provide additional ETI or LT training but rather evaluated these strategies under exist- ing practices and protocols. Randomized con- trolled trials are expensive to conduct, and there CONNECTING HEALTHCARE DATA How Interoperability Helped Fight Wildfire Data Systems Manager, Coastal Valleys EMS Tuesday, Nov. 6 th | 12pm CT The Reality of Stress: Moving Past "Get Over It" Epidemiologist, ImageTrend Tuesday, Nov. 27 th | 11am CT Choosing the Right Device for Field Use IT Manager & Firefighter/EMT, Hanover Fire-EMS Wednesday, Dec. 12 th | 11am CT REGISTER AT: ImageTrend.com/EVENTS our upcoming webinars How Interoperability Helped Fight Wildfire Data Systems Manager, Coastal Valleys EMS Data Systems Manager, Coastal Valleys EMS our upcoming webinars check out Hospital Licensing EMS Critical Care Reporting & Analysis CP/MIH Billing Preparedness Fire CONNECTING HEALTHCARE DATA just just More Than Software For More Information Circle 20 on Reader Service Card

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