Videolaryngoscopy (VL) is a promising tool to provide a safe airway during cardiopulmonary resuscitation (CPR) and to ensure early reoxygenation. Using data from the German Resuscitation Registry, we investigated the outcome of non-traumatic out-of-hospital cardiac arrest (OHCA) patients treated with VL versus direct laryngoscopy (DL) for airway management.We analysed retrospective data of 14,387 patients from 1 January 2018 until 31 December 2021 (VL group, n = 2201; DL group, n = 12186). Primary endpoint was discharge with cerebral performance categories one and two (CPC1/2). Secondary endpoints were the rate of return of spontaneous circulation (ROSC), hospital admission, hospital admission with ongoing cardiopulmonary resuscitation, 30-day survival/ hospital discharge and airway management complications. We used multivariate binary logistic regression analysis to identify the effects on outcome of known influencing variables and of VL vs DL.The multivariate regression model revealed that VL was an independent predictor of CPC1/2 survival (OR = 1.34, 95% CI = 1.12-1.61, p = 0.002) and of hospital discharge/30-day survival (OR = 1.26, 95% CI = 1.08-1.47, p = 0,004).VL for endotracheal intubation (ETI) at OHCA was associated with better neurological outcome in patients with ROSC. Therefore, the use of VL for OHCA offers a promising perspective. Further prospective studies are required.
Aim:We investigated the impact of video laryngoscopy (VL) compared with direct laryngoscopy (DL) in airway management on outcome for non-trauma out-of-hospital cardiac arrest (OHCA) patients from the German Resuscitation Registry.Methods:According to inclusion and exclusion criteria, we analysed retrospective data for 14,387 patients from 1 January 2018 until 31 December 2021 (VL group, n = 2201; DL group, n = 12186). Primary endpoint was discharge with cerebral performance categories 1 and 2 (CPC1/2). Secondary endpoints were rate of return of spontaneous circulation (ROSC), hospital admission, hospital admission with ongoing cardiopulmonary resuscitation, 30-day survival/ hospital discharge and airway management complications. We used a multivariate binary logistic regression model for primary endpoint of discharge with CPC1/2 and for 30-day survival/ hospital discharge. Subsequently, a matched-pair analysis with 15 identical characteristics was conducted for both groups (VL vs. DL: 1725 pairs).Results: Multivariate binary regression model revealed that VL was an independent predictor of CPC1/2 survival (OR = 1.38, 95% CI = 1.15–1.66). In the matched-pair analysis, 185/1725 (10.7%) VL-treated patients could be discharged with CPC1/2 status compared to 143/1725 (8.3%) DL-treated patients (p < 0.05, OR = 1.33, 95% CI = 1.06-1.67). Total ROSC and hospital discharge rates showed no significant difference.Conclusion:VL for endotracheal intubation (ETI) at OHCA improves the rate of favourable neurological outcome in patients with ROSC. Consequently, optimal airway strategy in our physician-staffed emergency medical services system should be adapted to ETI with first-line VL. The use of VL at OHCA should be increased in the future.
