Persons experiencing out-of-hospital cardiac arrests who were treated with supraglottic airway devices as their initial airway management strategy did not have favorable 30-day functional outcomes, according to a study published in JAMA.

The optimal form of out-of-hospital airway management during cardiac arrest is unknown. The current study’s objective was to assess whether a supraglottic airway device was superior to tracheal intubation in adults suffering an out-of-hospital, nontraumatic cardiac arrest through a cluster randomized, multicenter clinical trial of paramedics working in England. From June 2015 to August 2017, with follow-up concluding in February 2018, 9296 participants were treated by 759 paramedics randomly assigned to use a supraglottic airway device as their initial airway management strategy, and 764 paramedics randomly assigned to use tracheal intubation. Ultimately, 4886 individuals received treatment with a supraglottic airway device and 4410 were treated with tracheal intubation.

The primary outcome was a modified Rankin Scale score (0-3=good outcome, 4-6=poor outcome to death) at 30 days after cardiac arrest or at hospital discharge, whichever came first, and secondary outcomes were success of ventilation, aspiration, and regurgitation.

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Of the 9296 study participants, 9289 had known modified Rankin Scale Scores. Of the 4882 people in the supraglottic airway device group, 311 (6.4%) had good outcomes vs 300 (6.8%) of the 4407 people in the tracheal intubation group (adjusted risk difference, –0.6%; 95% CI, –1.6% to 0.4%). In the supraglottic airway device group, initial ventilation was successful in 87.4% of participants (4255 of 4868) compared with 79.0% of participants (3473 of 4397) in the tracheal intubation group (adjusted risk difference, 8.3%; 95% CI, 6.3%-10.2%). However, persons treated by paramedics using tracheal intubation were less likely to receive advanced airway management (77.6% of participants [3419 of 4404]) vs those treated by paramedics using supraglottic airway devices ((85.2% of participants [4161 of 4883]). Rates of regurgitation and aspiration were not significantly different between the groups.  

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The investigators concluded, “Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced airway management with a supraglottic airway device compared with tracheal intubation did not result in a favorable functional outcome at 30 days.”


Benger JR, Kirby K, Black S, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trialJAMA. 2018;320(8):779-791. doi:10.1001/jama.2018.11597