BVM or ETT in Arrest – New RCT

Spoon Feed
Bag mask ventilation and endotracheal intubation were equal for airway management in patients with cardiac arrest in terms of good neurological outcome at 28-days.

Why does this matter?
Last year, two articles were published that suggested outcomes were worse in both children and adults with cardiac arrest who had early intubation.  That was association, but was it causation?  This study takes the next step.

Reveal the verdict…we still don’t know
This was a RCT of 2043 cardiac arrest patients in France and Belgium, half randomized to bag mask ventilation (BMV) vs endotracheal intubation (ETI).  The primary outcome of survival with a good neurological outcome at 28-days was the same in each group, 4.3% and 4.2% for BMV and ETI, respectively.  They had difficult airway management, failure, and regurgitation more often with BMV than ETI.  There were 146 in the BMV group with rescue ETI; 55 were unable to be ventilated; 100 had gastric regurgitation during ventilation.  BMV was far from harmless.  On the other hand, there were 21 in the ETI group in which intubation failed and they received BMV, and 102 had recognized esophageal intubation. Overall, the end result for patients was the same.  One method was not superior to another.  Ryan Radecki quips, “BMV is not inferior, but not non-inferior, to ETI. This is why everyone hates Journal Club.”

Source
Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial.  JAMA. 2018 Feb 27;319(8):779-787. doi: 10.1001/jama.2018.0156.

Peer reviewed by Thomas Davis

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