The reality of advanced airway management during out of hospital cardiac arrest; why did paramedics deviate from their allocated airway management strategy during the AIRWAYS-2 randomised trial?

Kirby, K.; Lazaroo, M.; Green, J.; Hall, H.; Pilbery, R.; Whitley, G. A.; Voss, S.; Benger, J.

Abstract

Background: AIRWAYS-2 was a large multi-centre cluster randomised controlled trial investigating the effect on functional outcome of a supraglottic airway device (i-gel) versus tracheal intubation (TI) as the initial advanced airway during out-of-hospital cardiac arrest. We aimed to understand why paramedics deviated from their allocated airway management algorithm during AIRWAYS-2. Methods: This study employed a pragmatic sequential explanatory design utilising retrospective study data collected during the AIRWAYS-2 trial. Airway algorithm deviation data were analysed to categorise and quantify the reasons why paramedics did not follow their allocated strategy of airway management during AIRWAYS-2. Recorded free text entries provided additional context to the paramedic decision-making related to each category identified. Results: In 680 (11.7%) of 5800 patients the study paramedic did not follow their allocated airway management algorithm. There was a higher percentage of deviations in the TI group (399/2707; 14.7%) compared to the i-gel group (281/3088; 9.1%). The predominant reason for a paramedic not following their allocated airway management strategy was airway obstruction, occurring more commonly in the i-gel group (109/281; 38.7%) versus (50/399; 12.5%) in the TI group. Conclusion: There was a higher proportion of deviations from the allocated airway management algorithm in the TI group (399; 14.7%) compared to the i-gel group (281; 9.1%). The most frequent reason for deviating from the allocated airway management algorithm in AIRWAYS-2 was obstruction of the patient's airway by fluid. This occurred in both groups of the AIRWAYS-2 trial, but was more frequent in the i-gel group.

• Journal Article Type: Article
• Acceptance Date: Feb 4, 2023
• Online Publication Date: Feb 18, 2023
• Publication Date: Mar 1, 2023
• Deposit Date: Feb 27, 2023
• Publicly Available Date: Feb 27, 2023
• Journal: Resuscitation Plus
• Electronic ISSN: 2666-5204
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Pages: 100365
• Item Discussed: N/A
• DOI: https://doi.org/10.1016/j.resplu.2023.100365
• Keywords: Emergency medical services; Out-of-hospital cardiac arrest; Airway management; Paramedic Resuscitation; Advanced life support
• Public URL: https://uwe-repository.worktribe.com/output/10473641
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2666520423000085?via%3Dihub