ORCID Profile
0000-0003-3473-2579
Current Organisation
University of Tasmania
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Publisher: Informa UK Limited
Date: 10-10-2013
DOI: 10.3109/10903127.2013.831509
Abstract: To determine the differences in survival for out-of-hospital advanced airway intervention (AAI) compared with basic airway intervention (BAI) in cardiac arrest. AAI is commonly utilized in cardiac arrest in the out-of-hospital setting as a means to secure the airway. Observational studies and clinical trials of AAI suggest that AAI is associated with worse outcomes in terms of survival. No controlled trials exist that compares AAI to BAI. We conducted a bias-adjusted meta-analysis on 17 observational studies. The outcomes were survival, short-term (return of spontaneous circulation and to hospital admission), and longer-term (to discharge, to one month survival). We undertook sensitivity analyses by analyzing patients separately: those who were 16 years and older, nontrauma only, and attempted versus successful AAI. This meta-analysis included 388,878 patients. The short-term survival for AAI compared to BAI were overall OR 0.84(95% CI 0.62 to 1.13), for endotracheal intubation (ETI) OR 0.79 (95% CI 0.54 to 1.16), and for supraglottic airways (SGA) OR 0.59 (95% CI 0.39 to 0.89). Long-term survival for AAI were overall OR 0.49 (95% CI 0.37 to 0.65), for ETI OR 0.48 (95% CI 0.36 to 0.64), and for SGA OR 0.35 (95% CI 0.28 to 0.44). Sensitivity analyses shows that limiting analyses to adults, non-trauma victims, and instances where AAI was both attempted and successful did not alter results meaningfully. A third of all studies did not adjust for any other confounding factors that could impact on survival. This meta-analysis shows decreased survival for AAIs used out-of-hospital in cardiac arrest, but are likely biased due to confounding, especially confounding by indication. A properly conducted prospective study or a controlled trial is urgently needed and are possible to do.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.RESUSCITATION.2014.02.021
Abstract: Since their emergence from the operating theatre over a decade ago, supra-glottic airways (SGA) have become increasingly common in the management of out-of-hospital cardiac arrest (OOHCA) with laryngeal masks (LM) the most common SGA. The proliferation of LMs in the prehospital setting has occurred despite lower than expected rates of successful insertion being reported. We conducted a single-centre, prospective parallel-group, 'open label' randomised controlled trial in subjects with OOHCA (aged greater than or equal to 12 years of age weighing greater than or equal to 30 kg) were allocated to either the i-gel supraglottic airway (IG-SGA) or the Portex Soft Seal Laryngeal Mask (PSS-LM) within a large Australian ambulance service. Our hypothesis was that use of the IG-SGA, when compared to the Portex PSS-LM, would result in a higher rate of successful insertion in patients presenting with OOHCA. The primary outcome was successful insertion of the SGA. There were 51 patients randomised. Subjects had an average age of 65 years and 40% were female. There were no apparent differences in key demographic characteristics between groups. The IG-SGA had a significantly higher success rate than the PSS-LM (90% versus 57% p=0.023), resulting in a 58% greater likelihood of successful insertion than the PSS-LM (RR 1.58 95% CI 1.11-2.24). The IG-SGA was associated with significantly lower median "ease of insertion" scores. The i-gel supraglottic airway was associated with higher successful insertion rates in subjects with out-of-hospital cardiac arrest.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
No related grants have been discovered for Richard Thomas.