Up to 60,000 people suffer an out of hospital cardiac arrest (OHCA) in the United Kingdom (UK) every year. Unfortunately only 10% of these people survive, so improvements in treatment are needed urgently.
Effective airway management and rescue breathing are essential for survival from OHCA, but the best way for paramedics to provide this is currently unknown. Now, high quality research in this area has been successfully completed for the first time.
Findings from a pilot study entitled ‘REVIVE-Airways’, led by a partnership between the University of the West of England(UWE Bristol), University Hospitals Bristol NHS Foundation Trust and South Western Ambulance Service NHS Foundation Trust will be presented on Friday 29 November 2013.
Previous studies in this area have only observed what paramedics do during OHCA: for the first time REVIVE-Airways has completed an interventional research trial, to find out which type of rescue breathing is most likely to improve survival, and demonstrating that this approach to studying the problem can be highly successful.
The results from this study, funded by the National Institute for Health Research, will be used to inform a larger trial that will determine future guidelines used both nationally and internationally.
Professor Jonathan Benger (UWE Bristol and UHBristol), the project lead, will be joined by paramedics from South Western Ambulance Service NHS Foundation Trust (SWAST) and other researchers to present the outcomes of REVIVE-Airways, and their recommendations for the future, at the UWE Exhibition and Conference Centre on Friday 29 November from 13.30 to 16.45. This presentation follows initial reports at international resuscitation and intensive care conferences in Europe and the USA.
REVIVE-Airways used a novel approach that involved working with SWAST paramedics to compare three alternative ways of managing a patient’s airway during cardiopulmonary resuscitation (CPR). Following additional training, and the approval of an NHS Ethics Committee, paramedics used one of two new second generation supraglottic airway devices (SADs) or their usual procedures when attending patients in cardiac arrest over a 12 month period. They also recorded any changes to their initial airway management, and the reasons that these were required.
Professor Jonathan Benger explains, “This has been a fantastic collaboration, with the number of paramedics taking the opportunity to become involved in this important project exceeding our initial recruitment expectations. This, in turn, meant that we were able to include more patients, strengthening our results.
“When the heart stops outside hospital, this is a dire medical emergency. Current resuscitation guidelines place a strong emphasis on life support which includes continuous chest compressions and clearing the patient’s airway to provide rescue breathing. Traditionally tracheal intubation (placing a breathing tube in the windpipe) has been regarded as the best way of managing the patient’s airway during OHCA, but recently new supraglottic airway devices (SADs) have become available, and we wanted to examine what advantages utilising SADs over or alongside older techniques might have on patient survival. We were also able to identify the initial airway management used by paramedics attending OHCA, the subsequent techniques used and the reasons for any changes that needed to occur.”
• For the first time this research has demonstrated that a study of alternative approaches to airway management in OHCA is feasible. Recruitment of both paramedics and patients exceeded pre-determined targets, and there was consistent recruitment with excellent data quality.
• Valuable data were obtained from all of the 615 patients enrolled in REVIVE-Airways.
• This study also described, for the first time, usual paramedic practice when managing the airway during OHCA, and demonstrated that a variety of techniques are used according to clinical judgement and patient need.
• The study found no significant differences in important clinical outcomes between the use of a SAD and tracheal intubation during OHCA, but a larger research trial is required to decide whether one technique should be used in preference to another. However the i-gel proved superior to the LMAS on several measures, and will therefore be compared to the i-gel with tracheal intubation in a subsequent, large scale trial.
Professor Benger added, “We are delighted to have successfully completed this ground-breaking research study, and look forward to presenting our results. We are confident that this work will help to improve survival from cardiac arrest throughout the UK and internationally.”