ABSTRACTS
Early Versus Delayed Advanced Airway Management in OHCA: A Nationwide Korean EMS Cohort StudyAuthor: JungHo Lee | Assistant Professor | Chonnam national university hospital Associate Authors:
Background The optimal timing of advanced airway management (AAM) during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) remains unclear. This study aimed to evaluate the association between early AAM and clinical outcomes using time-dependent propensity score matching (TDPSM) and structural equation modeling (SEM). Methods This retrospective cohort study analyzed nationwide OHCA data from 2019 to 2022. Early AAM was defined as airway placement within 6 minutes from initiating chest compression. TDPSM was performed to compare early versus delayed AAM groups based on pre-defined covariates. Generalized estimating equations were used to evaluate associations with prehospital return of spontaneous circulation (ROSC), survival to discharge, and good neurological recovery. SEM was conducted within the matched cohort to identify factors associated with delayed airway placement. Results After TDPSM, 24,028 matched patients were analyzed. Compared to delayed AAM, early AAM was associated with increased prehospital ROSC (adjusted risk ratio [aRR], 1.21; 95% CI, 1.12–1.29) and good neurological recovery (aRR, 1.12; 95% CI, 1.01–1.23). In the SEM analysis conducted in the matched cohort, time to initial rhythm analysis (b = 0.611), epinephrine administration (b = 0.244), and defibrillation (b = 0.228) were statistically significantly associated with delays in AAM. Endotracheal intubation was also associated with longer AAM delay compared to supraglottic airway use (b = 0.865–2.254). Conclusions Early AAM was significantly associated with better outcomes in OHCA patients. However, SEM findings highlight that AAM timing is closely linked to the sequence of other time-sensitive interventions, emphasizing the importance of procedural coordination in prehospital care.
|
