Taking ECG Rhythm And Ventilation To Heart

Whether or not a cardiac patient presents with a shockable ECG rhythm affects the type of airway management technique administered, say researchers in Japan.

AsianScientist (Mar. 18, 2019) – Scientists in Japan have found that the speed and type of ventilation treatment administered to patients suffering cardiac arrest does not only affect life or death in the immediate term, but also impacts health outcomes after successful resuscitation. They published their findings in The BMJ.

During out-of-hospital cardiac arrest, effective treatment starts with cardiopulmonary resuscitation (CPR) and, if necessary, electric shock by a defibrillator. In performing the process, emergency medical service personnel also provide oxygen and ventilation either by the bag-valve-mask method or via more invasive advanced airway management (AAM) techniques, such as tube insertion, to keep the airway open. The ventilation methods have pros and cons in the immediate and longer term.

In this study, a team led by Assistant Professor Sho Komukai of Osaka University, Japan, sought to identify patterns in the ventilation method and patients’ one-month outcome after survival. The researchers used data from more than 300,000 OHCA cases in the large-scale All-Japan Utstein Registry of the Fire and Disaster Management Agency of Japan.

Applying an advanced statistical technique called time-dependent propensity-score sequential-matching analysis, the researchers were able to account for the timing of AAM administration and offsets bias from patients undergoing longer resuscitation and receiving more interventions. The researchers found that patient outcomes differed based on patients’ first-documented ECG rhythm.

“Shockable patients [those whose condition warranted defibrillation] did not have improved one-month outcomes after AAM. However, non-shockable patients treated with AAM showed better outcomes,” said Komukai.

Favorable outcomes included recovering neurological functioning and early hospital discharge, whereas unfavorable outcomes included loss of brain function and death.

The scientists thus recommended that patients presenting with a shockable rhythm should receive immediate defibrillation and continuous chest-compression rather than ventilatory support. However, non-shockable rhythm could benefit from oxygen delivery with AAM.

The article can be found at: Izawa et al. (2019) Prehospital Advanced Airway Management for Adult Patients with Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study.


Source: Osaka University; Photo: Shutterstock.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

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