RESUSCITATION AIRWAY MANAGEMENT AT A TERTIARY CARE CENTER THAT ENCOURAGES FIRST-CHOICE SUPRAGLOTTIC AIRWAY USE

ABSTRACT

SESSION TITLE Hot Topics in Critical Care SESSION TYPE Original Investigations PRESENTED ON 10/18/2022 0245 pm - 0345 pm PURPOSE: Recent data from the national American Heart Association Get with the Guidelines Resuscitation registry suggests substantial hospital-to-hospital variation in airway management during in-hospital cardiac arrest (IHCA), with most patients undergoing endotracheal intubation. Less than 5% of IHCA patients receive a supraglottic airway (SGA). Over the past several years, SGAs have been studied extensively in out-of-hospital cardiac arrests (OHCA) with promising results and are widely used in the OHCA setting. In this study, we describe factors and airway characteristics at a center encouraging either SGA or endotracheal intubation (ETI) for IHCA advanced airway management. METHODS: We performed a retrospective observational study examining all cardiac arrests occurring at a multi-campus academic medical center between August 3, 2020 to July 11, 2021. Locations studied included general medical wards, telemetry units, and intensive care units (both medical and specialty ICUs, such as surgical or cardiac). Patients were excluded if they possessed an invasive airway at time of arrest, suffered an arrest in the ED or procedural areas (e.g., operating room, catheterization lab), or were SARS-CoV-2 positive. Of note, SGAs were not specifically discouraged during the COVID-19 pandemic at this institution. We compared patient, arrest, and airway characteristics between the SGA and endotracheal intubation (ETI) groups using t-tests or Fisher’s exact tests where appropriate. Given risk for confounding by indication, we did not compare patient outcomes between groups. RESULTS: A total of 97 patients were included in the study, of whom 82 (84.5%) received an advanced airway during cardiopulmonary resuscitation. Of these the initial airway was ETI in 46 (56.1%) arrests and SGA in 36 (43.9%) arrests. As compared to SGA, patients receiving ETI were younger (66.1 [±2.0] vs. 71.2 [±2.1], p=0.08), more likely to be obese (11.0% vs. 5.6%), and more likely to have pre-existing lung conditions (19.6% vs 11.1%)—although no difference reached the a priori defined α<0.5 level of significance. Other hypothesized differences were not as extreme including for body mass index (28.3 [±1.4] vs. 28.4 [±1.6]) and respiratory cause of arrest (34.8% vs. 47.2%). First pass success rate was 84.8% for ETI. Complications of airway management were rare with one patient in each group suffering vomiting, one instance of oropharyngeal bleeding in the SGA group, and one pneumothorax in the ETI group. CONCLUSIONS: At a center using both SGA and ETI during IHCA response, patients who were younger, more obese, and more commonly had underlying lung disease tended to receive ETI—although these associations were not statistically significant. Complications of both advanced airway modalities were rare. CLINICAL IMPLICATIONS DISCLOSURES No relevant relationships by jonathan daich No relevant relationships by Alex Li No relevant relationships by Ari Moskowitz No relevant relationships by Aron Soleiman