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.

Citation

Kirby, K., Lazaroo, M., Green, J., Hall, H., Pilbery, R., Whitley, G. A., …Benger, J. (2023). 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?. Resuscitation Plus, 13, 100365. https://doi.org/10.1016/j.resplu.2023.100365

• 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