Out-of-hospital airway management with a laryngeal tube or endotracheal intubation for out-of-hospital cardiac arrest Influence on in-hospital mortality

Background Endotracheal (ET) intubation has been the gold standard in out-of-hospital airway management for a long time. Recent guidelines suggest an alternative airway management with supraglottic airway devices like the laryngeal tube (LT) especially for less experienced rescue personnel. However, scientific evidence on the prognostic impact of the laryngeal tube in the setting of cardiopulmonary resuscitation is limited. Methods We aimed to compare mortality outcomes in out-of-hospital cardiac arrest (OHCA) patients after preclinically initiated airway management with either ET or LT in a propensity score matched, single-center retrospective analysis. Results A total of 208 patients with OHCA were resuscitated and intubated with either ET (n& x202f;= 160; 77%) or LT (n& x202f;= 48; 23%) in the urban area of Frankfurt am Main, Germany, and treated thereafter on the intensive care unit of the University Hospital Frankfurt from 2006-2014. In-hospital mortality was 84% versus 85% in the ET and LT group (p& x202f;= 0.86). No difference regarding in-hospital mortality has been observed between the two airway management techniques in univariate as well as in multivariate mortality analysis (HR& x202f;= 0.98, 95% confidence interval [CI] 0.69-1.39; p& x202f;= 0.92; adjusted HR& x202f;= 1.01, 95% CI 0.76-1.56; p& x202f;= 0.62). To adjust for potential confounders, propensity score matching was additionally performed resulting in a cohort of 120 matched patients in a 3:1 ratio (ET:LT). Again, survival to hospital discharge was comparable between the two patient groups (propensity-adjusted HR& x202f;= 0.99, 95% CI 0.65-1.51, p& x202f;= 0.97). Further, preclinical airway management with LT or ET showed no difference in mortality within first 24& x202f;h (propensity-adjusted HR& x202f;= 1.02; 95% CI 0.44-2.36; p& x202f;= 0.96). Conclusion Preclinical airway management with LT shows similar mortality outcomes in direct comparison to intubation with ET in OHCA patients. Further randomized studies are warranted.