AIRWAY-2
Trial question
What is the effect of a strategy of advanced airway management with a supraglottic airway device among patients with out-of-hospital cardiac arrest?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 9296
9296 patients (3373 female, 5923 male)
Inclusion criteria: adult patients who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic
Key exclusion criteria: resuscitation deemed inappropriate; advanced airway already in place when a paramedic participating in the trial arrived at the patient's side; and the patient's mouth opening < 2 cm
Interventions
N=4886 supraglottic airway device (i-gel use; Intersurgical by 759 paramedics)
N=4410 tracheal intubation (direct laryngoscopy use764 by paramedics)
Primary outcome
Good outcome; modified Rankin Scale score range of 0-3
6.4
6.8
6.8 %
5.1 %
3.4 %
1.7 %
0.0 %
Supraglottic airway device
Tracheal intubation
No significant difference ↔
No significant difference in good outcome; mRS score range of 0-3 (6.4% vs. 6.8%; aOR 0.92, 95% CI 0.77 to 1.09)
Secondary outcomes
No significant difference in survival at 72 hour (13.6% vs. 13.1%; OR 1.04, 95% CI 0.92 to 1.18)
Significant increase in initial ventilation success; ≤ 2 attempts at advanced airway management (87.4% vs. 79%; OR 1.92, 95% CI 1.66 to 2.22)
Significant increase in any unintended loss of a previously established airway (10.6% vs. 5%; OR 2.29, 95% CI 1.86 to 2.82)
Safety outcomes
No significant differences in regurgitation, aspiration.
Significant difference in return of spontaneous circulation at arrival to the emergency department or hospital (30.6% vs. 28.4%).
Conclusion
In adult patients who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic, supraglottic airway device was not superior to tracheal intubation with respect to good outcome; mRS score range of 0-3.
Reference
Jonathan R Benger, Kim Kirby, Sarah Black 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 Trial. JAMA. 2018 Aug 28;320(8):779-791.
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