Heart Health

20 September 2018

Newer breathing tube might save more cardiac arrest patients

Laryngeal tubes provide an easier, simpler way to open an airway and improve survival rates in cases of cardiac arrest.

Changing the type of breathing tube that first responders use to resuscitate cardiac arrest patients can boost the chances of survival, a new study contends.

There are about 400 000 out-of-hospital cardiac arrests in the United States each year. More than 90% of those patients die before, or soon after, they reach the hospital.

Cardiac arrest occurs when the heart suddenly stops beating, cutting off blood flow to the brain and other vital organs.

The standard resuscitation technique used by emergency medical service (EMS) providers has been insertion of a plastic tube into the trachea, known as endotracheal intubation, to maintain an open airway. This is meant to mirror the care given in hospitals.

Getting it right

But new devices such as laryngeal tubes provide an easier, simpler way to open an airway and improve survival rates, according to the study funded by the US National Heart, Lung, and Blood Institute (NHLBI).

"While identical to techniques used by doctors in the hospital, intubation in these severe and stressful pre-hospital settings is very difficult and fraught with errors," explained study lead author Dr Henry Wang. He's vice chair for research with the University of Texas Health Science Center's department of emergency medicine.

Study co-author Dr George Sopko is programme director in the division of cardiovascular sciences at the NHLBI. He noted that getting it right is critical.

"During resuscitation, opening the airway and having proper access to it is a key factor for the survival of someone who goes into cardiac arrest outside of a hospital," Sopko said in an institute news release.

"But one of the burning questions in pre-hospital emergency care has been, 'Which is the best airway device?'" he said.

Managing the airway

"This study demonstrated that just by managing the airway well in the early stage of resuscitation, we could save more than 10 000 lives every year," Sopko added.

The researchers compared survival rates among 3 000 adult cardiac arrest patients in five large US cities. About half the patients received the newer laryngeal tube treatment, while the other half received traditional endotracheal intubation. The findings were published online in the Journal of the American Medical Association.

In the laryngeal tube group, 18.3% of patients survived three days in the hospital and 10.8% survived until being discharged from the hospital. The survival rates in the traditional endotracheal intubation group were 15.4% and 8.1%, respectively.

The researchers also found that rates of survival with good brain function were higher in the laryngeal tube group.

Image credit: iStock