![]() In cases where standard BMV was impossible, or in case of massive regurgitation of gastric contents during ventilation, ETI or SGA were recommended. The choice of airway management strategy was left to the judgment of paramedics. Before applying ETI or SGA, a synchronized 30-to-2 compressions/ventilation ratio was attained, with ventilation provided by a bag-valve-mask (BVM) with minimalized interruptions (within 10 seconds). The defibrillator pads were promptly connected to check the rhythm and defibrillated if necessary. EMTs provided CPR according to the standard guidelines with emphasis on high-quality chest compressions (rate 100–120 min−1, depth 5–6 cm, allowing full recoil of chest after each compression, and minimizing interruptions). Patients were transported to tertiary care hospitals, where standardized post-resuscitation care was provided according to predefined protocols. ![]() At least one of the EMTs was a paramedic who was able to provide defibrillation, intravenous adrenaline, and advanced airway management by tracheal intubation or, alternatively, by supraglottic devices. Three to four emergency medical technicians (EMTs) in one ambulance were dispatched to the cardiac arrest event. All data were retrospectively collected from the Utstein style database of the Emergency Medical Services (EMS) of the Hakusan-Nonoichi fire department. Patients who were already experiencing cardiac arrest at the time of EMS arrival and intervention were included in the study. This study included data from patients who experienced out-of-hospital cardiac arrest in Hakusan-Nonoich region, Ishikawa, Japan between April 2015 and March 2017. It has also been pointed out that ETI by paramedics in hospitals may worsen the prognosis of cardiac arrest patients 6, 7 The purpose of this study was to determine the optimal airway management strategy for prehospital care by paramedics by investigating the impact of prehospital advanced airway management on CCF and ROSC in OHCA patients. However, the relationship between the effect of airway management in OHCA on actual CCF and patient outcomes is unknown. Advanced airway management with endotracheal intubation (ETI) or supraglottic airway devices (SGA) allows ventilation without interruption of chest compressions and is expected to increase CCF. Interruption for ventilation as synchronous CPR may have a significant impact on CCF. 5 Two methods are used for chest compressions and ventilation during cardiopulmonary resuscitation: synchronous CPR, a cycle of 30 uninterrupted chest compressions with a cycle of two ventilations or asynchronous CPR, and uninterrupted ventilation with advanced airway management. Among them, the interruption time of chest compressions for ventilation may have a significant impact on CCF. 4ĭuring prehospital resuscitation, rescuers may stop chest compressions for many reasons that are integral to patient care, such as ventilation, assessing heart rhythm and pulse, defibrillation, or tracheal intubation. 2, 3 American Heart Association guidelines for cardiopulmonary resuscitation recommend maintaining the CCF above 80% during CPR. Maintaining a high chest compression fraction (CCF percentage of time patients received compressions through constant chest compressions) is considered a key factor in achieving return of spontaneous circulation (ROSC) of OHCA resuscitation. “High-quality CPR” is key to improving the chance of survival for OHCA patients. More than 120,000 out-of-hospital cardiac arrest (OHCA) victims were transported to the emergency room in Japan in 2015.Their one-month survival rates are low at <10%, 1 and improving prognosis of these cases is an urgent issue.
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