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Should Supraglottic Airways Be Used in Arrest?

October 18, 2017

Spoon Feed
Use of a supraglottic airway (SGA) was associated with improved survival with a good neurological outcome.

Why does this matter?
Prior studies have shown conflicting results with the use of a SGA in arrest.  One suggested that compared with endotracheal intubation, patients with a SGA fared worse.  Now this study shows it was associated with a big improvement.  It’s hard to know how this fits in the broader picture.

It’s great to be a SGA…
This was a retrospective study of data that was originally prospectively collected.  This final tally included 254 people with a cardiac cause of arrest, ROSC, admitted to the ICU.  They found after adjusting for other confounders that patients who had a SGA had an OR for neurologically intact survival of 7.9, which is impressive.  But only 37 people had survival with good neurological outcome, so the total numbers with a better outcome were small: 12/37 (32.4%) vs 39/217 (18%) – with SGA vs. without SGA, respectively.  Given the retrospective nature, it is hard to get too excited about these results.  Maybe placement of an SGA was a marker of superior care overall and higher quality CPR.  We just don’t know.  It seems, on the basis of high quality data, that it is most important to focus on chest compressions and CPR quality and focus less on an advanced airway.  But take this for what it’s worth – at the very least, a SGA did not appear harmful and may have been a benefit to neurologically intact survival in arrest.

Pre-hospital Supraglottic Airway was Associated with Good Neurological Outcome in Cardiac Arrest Victims Especially Who Received Prolonged Cardiopulmonary Resuscitation.  Acad Emerg Med. 2017 Sep 12. doi: 10.1111/acem.13309. [Epub ahead of print]

Another Spoonful
Taming the SRU has an excellent expose on ETT vs SGA in arrest.

Peer reviewed by Thomas Davis, MD

What are your thoughts?