Time to advanced airway management and neurologically favorable survival after out-of-hospital cardiac arrest

Background: There is controversy as to which is superior, basic or advanced airway management (AAM), for out-of-hospital cardiac arrest (OHCA) in the prehospital setting. The effect of AAM may differ depending on the timing. Aim: We sought to determine whether time to AAM is associated with a neurological status after OHCA. Methods: This was a nationwide population-based study based on the government-led registry data of OHCA. We included OHCA patients who received prehospital AAM by EMS personnel in Japan from 2014 to 2017. The primary outcome was 1-month neurologically favorable survival. Outcomes were compared with logistic regression with treating time to AAM as both categorical and continuous variable and for a propensity-matched subset of patients. Results: A total of 16445 patients were included. Of these, 1618 (1.0%) survived without sequelae. The median time to AAM was 17min (IQR, 14–22min). Longer time to AAM was associated with a decreased chance of neurologically favorable survival as in the Figure when treated as categorical variable. When treated as continuous variable, multivariable-adjusted OR per minute delay in time to AAM was 0.90 (95%CI 0.90–0.91). In a propensity score-matched analysis (Time to AAM ≤20 vs >20min), similar association was observed (RR 0.43, 95%CI 0.36–0.50). Conclusion: Delayed AAM was associated with a decreased chance of neurologically favorable survival after OHCA.