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Scott, Lauren J. - One of the best experts on this subject based on the ideXlab platform.

  • Effect of a strategy of a Supraglottic Airway Device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    Importance The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. Objective To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. Design, Setting, and Participants Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. Interventions Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. Main Outcomes and Measures The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. Results A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). Conclusions and Relevance Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

  • 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
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    © 2018 American Medical Association. All rights reserved. IMPORTANCE The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. OBJECTIVE To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. INTERVENTIONS Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. MAIN OUTCOMES AND MEASURES The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. RESULTS A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

Benger, Jonathan R. - One of the best experts on this subject based on the ideXlab platform.

  • Randomized trial of the i-gel Supraglottic Airway Device versus tracheal intubation during out of hospital cardiac arrest (AirwayS-2): Patient outcomes at three and six months
    'Elsevier BV', 2020
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Voss Sarah, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria
    Abstract:

    © 2020 The Author(s) Aim: The AirwayS-2 cluster randomised controlled trial compared the i-gel Supraglottic Airway Device (SGA) with tracheal intubation (TI) as the first advanced Airway management (AAM) strategy used by Emergency Medical Service clinicians (paramedics) treating adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA). It showed no difference between the two groups in the primary outcome of modified Rankin Scale (mRS) score at 30 days/hospital discharge. This paper reports outcomes to 6 months. Methods: Paramedics from four ambulance services in England were randomised 1:1 to use an i-gel SGA (759 paramedics) or TI (764 paramedics) as their initial approach to AAM. Adults who had a non-traumatic OHCA and were attended by a participating paramedic were enrolled automatically under a waiver of consent. Survivors were invited to complete questionnaires at three and six months after OHCA. Outcomes were analysed using regression methods. Results: 767/9296 (8.3%) enrolled patients survived to 30 days/hospital discharge and 317/767 survivors (41.3%) consented and were followed-up to six months. No significant differences were found between the two treatment groups in the primary outcome measure (mRS score: 3 months: odds ratio (OR) for good recovery (i-gel/TI, OR) 0.89, 95% CI 0.69–1.14; 6 months OR 0.91, 95% CI 0.71–1.16). EQ-5D-5L scores were also similar between groups and sensitivity analyses did not alter the findings. Conclusion: There were no statistically significant differences between the TI and i-gel groups at three and six months. We therefore conclude that the initially reported finding of no significant difference between groups at 30 days/hospital discharge was sustained when the period of follow-up was extended to six months

  • Effect of a strategy of a Supraglottic Airway Device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    Importance The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. Objective To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. Design, Setting, and Participants Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. Interventions Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. Main Outcomes and Measures The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. Results A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). Conclusions and Relevance Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

  • 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
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    © 2018 American Medical Association. All rights reserved. IMPORTANCE The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. OBJECTIVE To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. INTERVENTIONS Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. MAIN OUTCOMES AND MEASURES The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. RESULTS A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

Robinson Maria - One of the best experts on this subject based on the ideXlab platform.

  • Randomized trial of the i-gel Supraglottic Airway Device versus tracheal intubation during out of hospital cardiac arrest (AirwayS-2): Patient outcomes at three and six months
    'Elsevier BV', 2020
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Voss Sarah, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria
    Abstract:

    © 2020 The Author(s) Aim: The AirwayS-2 cluster randomised controlled trial compared the i-gel Supraglottic Airway Device (SGA) with tracheal intubation (TI) as the first advanced Airway management (AAM) strategy used by Emergency Medical Service clinicians (paramedics) treating adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA). It showed no difference between the two groups in the primary outcome of modified Rankin Scale (mRS) score at 30 days/hospital discharge. This paper reports outcomes to 6 months. Methods: Paramedics from four ambulance services in England were randomised 1:1 to use an i-gel SGA (759 paramedics) or TI (764 paramedics) as their initial approach to AAM. Adults who had a non-traumatic OHCA and were attended by a participating paramedic were enrolled automatically under a waiver of consent. Survivors were invited to complete questionnaires at three and six months after OHCA. Outcomes were analysed using regression methods. Results: 767/9296 (8.3%) enrolled patients survived to 30 days/hospital discharge and 317/767 survivors (41.3%) consented and were followed-up to six months. No significant differences were found between the two treatment groups in the primary outcome measure (mRS score: 3 months: odds ratio (OR) for good recovery (i-gel/TI, OR) 0.89, 95% CI 0.69–1.14; 6 months OR 0.91, 95% CI 0.71–1.16). EQ-5D-5L scores were also similar between groups and sensitivity analyses did not alter the findings. Conclusion: There were no statistically significant differences between the TI and i-gel groups at three and six months. We therefore conclude that the initially reported finding of no significant difference between groups at 30 days/hospital discharge was sustained when the period of follow-up was extended to six months

  • Effect of a strategy of a Supraglottic Airway Device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    Importance The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. Objective To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. Design, Setting, and Participants Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. Interventions Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. Main Outcomes and Measures The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. Results A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). Conclusions and Relevance Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

  • 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
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    © 2018 American Medical Association. All rights reserved. IMPORTANCE The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. OBJECTIVE To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. INTERVENTIONS Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. MAIN OUTCOMES AND MEASURES The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. RESULTS A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

Lazaroo, Michelle J. - One of the best experts on this subject based on the ideXlab platform.

  • Randomized trial of the i-gel Supraglottic Airway Device versus tracheal intubation during out of hospital cardiac arrest (AirwayS-2): Patient outcomes at three and six months
    'Elsevier BV', 2020
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Voss Sarah, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria
    Abstract:

    © 2020 The Author(s) Aim: The AirwayS-2 cluster randomised controlled trial compared the i-gel Supraglottic Airway Device (SGA) with tracheal intubation (TI) as the first advanced Airway management (AAM) strategy used by Emergency Medical Service clinicians (paramedics) treating adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA). It showed no difference between the two groups in the primary outcome of modified Rankin Scale (mRS) score at 30 days/hospital discharge. This paper reports outcomes to 6 months. Methods: Paramedics from four ambulance services in England were randomised 1:1 to use an i-gel SGA (759 paramedics) or TI (764 paramedics) as their initial approach to AAM. Adults who had a non-traumatic OHCA and were attended by a participating paramedic were enrolled automatically under a waiver of consent. Survivors were invited to complete questionnaires at three and six months after OHCA. Outcomes were analysed using regression methods. Results: 767/9296 (8.3%) enrolled patients survived to 30 days/hospital discharge and 317/767 survivors (41.3%) consented and were followed-up to six months. No significant differences were found between the two treatment groups in the primary outcome measure (mRS score: 3 months: odds ratio (OR) for good recovery (i-gel/TI, OR) 0.89, 95% CI 0.69–1.14; 6 months OR 0.91, 95% CI 0.71–1.16). EQ-5D-5L scores were also similar between groups and sensitivity analyses did not alter the findings. Conclusion: There were no statistically significant differences between the TI and i-gel groups at three and six months. We therefore conclude that the initially reported finding of no significant difference between groups at 30 days/hospital discharge was sustained when the period of follow-up was extended to six months

  • Effect of a strategy of a Supraglottic Airway Device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    Importance The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. Objective To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. Design, Setting, and Participants Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. Interventions Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. Main Outcomes and Measures The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. Results A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). Conclusions and Relevance Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

  • 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
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    © 2018 American Medical Association. All rights reserved. IMPORTANCE The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. OBJECTIVE To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. INTERVENTIONS Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. MAIN OUTCOMES AND MEASURES The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. RESULTS A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

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  • Randomized trial of the i-gel Supraglottic Airway Device versus tracheal intubation during out of hospital cardiac arrest (AirwayS-2): Patient outcomes at three and six months
    'Elsevier BV', 2020
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Voss Sarah, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria
    Abstract:

    © 2020 The Author(s) Aim: The AirwayS-2 cluster randomised controlled trial compared the i-gel Supraglottic Airway Device (SGA) with tracheal intubation (TI) as the first advanced Airway management (AAM) strategy used by Emergency Medical Service clinicians (paramedics) treating adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA). It showed no difference between the two groups in the primary outcome of modified Rankin Scale (mRS) score at 30 days/hospital discharge. This paper reports outcomes to 6 months. Methods: Paramedics from four ambulance services in England were randomised 1:1 to use an i-gel SGA (759 paramedics) or TI (764 paramedics) as their initial approach to AAM. Adults who had a non-traumatic OHCA and were attended by a participating paramedic were enrolled automatically under a waiver of consent. Survivors were invited to complete questionnaires at three and six months after OHCA. Outcomes were analysed using regression methods. Results: 767/9296 (8.3%) enrolled patients survived to 30 days/hospital discharge and 317/767 survivors (41.3%) consented and were followed-up to six months. No significant differences were found between the two treatment groups in the primary outcome measure (mRS score: 3 months: odds ratio (OR) for good recovery (i-gel/TI, OR) 0.89, 95% CI 0.69–1.14; 6 months OR 0.91, 95% CI 0.71–1.16). EQ-5D-5L scores were also similar between groups and sensitivity analyses did not alter the findings. Conclusion: There were no statistically significant differences between the TI and i-gel groups at three and six months. We therefore conclude that the initially reported finding of no significant difference between groups at 30 days/hospital discharge was sustained when the period of follow-up was extended to six months

  • Effect of a strategy of a Supraglottic Airway Device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    Importance The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. Objective To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. Design, Setting, and Participants Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. Interventions Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. Main Outcomes and Measures The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. Results A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). Conclusions and Relevance Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days

  • 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
    'American Medical Association (AMA)', 2018
    Co-Authors: Benger, Jonathan R., Lazaroo, Michelle J., Clout Madeleine, Black Sarah, Brett, Stephen J., Kirby Kim, Nolan, Jerry P., Reeves, Barnaby C., Robinson Maria, Scott, Lauren J.
    Abstract:

    © 2018 American Medical Association. All rights reserved. IMPORTANCE The optimal approach to Airway management during out-of-hospital cardiac arrest is unknown. OBJECTIVE To determine whether a Supraglottic Airway Device (SGA) is superior to tracheal intubation (TI) as the initial advanced Airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. INTERVENTIONS Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced Airway management strategy. MAIN OUTCOMES AND MEASURES The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. RESULTS A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced Airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced Airway management with a Supraglottic Airway Device compared with tracheal intubation did not result in a favorable functional outcome at 30 days