EMS World

DEC 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 56 of 83

56 DECEMBER 2018 | EMSWORLD.com EVIDENCE-BASED MEDICINE associated with such interruptions. We know from other studies that excessive compression pauses are associated with wor s e outcom e s . This pap er did not report on the proportion of patients who experienced compression interruptions in either group. This would be a helpful piece of information. Fortunately, some of the systems in this trial used moni- tors that recorded compression quality. This data is being analyzed in a second- ar y analysis and might shed additional light on this question. My bottom line on this ver y important and wonderfully done study is that inser- tion of an LT in cardiac arrest results in better sur vival than a poorly inserted ETI. I don't know, however, what the impact would be in agencies with better ETI per- formance. I took a deeper dive into this study a n d d e s cr i b e d i t f o r th e F OA MFr at blog here: w w w.foamfrat.com /single- p o s t / 201 8 /0 9/0 9/ I s - E n d o t r a c h e a l - Intubation-PART- Of-The-Reason-For- Poor-Cardiac-Arrest-Sur vival. AIRWAYS-2 Like the PART study, AIRWAYS-2 is a large pragmatic prospective randomized trial of air way management in out-of-hospital cardiac arrest. The lead author was Dr. Jonathan Benger, and it was also pub- lished in JAMA in 2018. 2 This study was conducted by four U.K. ambulance ser- vices covering 21 million citizens, more than 40% of th e U.K. p o p ulatio n. It compared endotracheal intubation (per- formed exclusively with direct lar yngos- copy) to the i-gel SGA. Unlike the PART study, which random- ized EMS agencies, this trial randomized paramedics to either intubation or SGA. Personally I prefer this methodolog y. Both ETI and SGA require specific skills that benefit from maintenance. I worr y that switching back and for th between the dif ferent approaches could cause some skill decay, something more likely w ith intu b atio n than SGA . T h e AIR- WAYS-2 trial recruited paramedics who A strategy of either SGA or ETI as the initial airway in cardiac arrest is reasonable. The AIRWAYS-2 trial compared endotracheal intubation to the i-gel SGA.

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