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NIH Study Shows Laryngeal Tubes More Effective Than Intubation

The Register-Herald, Beckley, W.Va.

Aug. 28—A new National Institutes of Health (NIH) study has shown that a change in the type of breathing tube paramedics use to resuscitate patients with sudden cardiac arrest can significantly improve the odds of survival and save thousands of lives.

The release said more than 90 percent of Americans who experience sudden cardiac arrest die before, or soon after, reaching a hospital. Usually caused by a heart attack, sudden cardiac arrest occurs when the heart suddenly or unexpectedly stops beating, cutting off blood flow to the brain and other vital organs.

"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," said George Sopko, M.D., M.P.H., program director in the NHLBI's Division of Cardiovascular Sciences and coauthor of the study.

"But one of the burning questions in prehospital emergency care has been, 'Which is the best airway device?'"

Funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH, this study is the largest of its kind to test oxygen delivery methods used by firefighters, emergency medical service (EMS) providers and paramedics. It is the first to show that a particular airway intervention can positively affect patient survival rates.

"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 said.

EMS providers treat the majority of the 400,000 out-of-hospital cardiac arrests each year. For more than three decades, their standard-of-care technique for resuscitation has been endotracheal intubation—the insertion of a plastic tube into the trachea to maintain an open airway. They use this technique in hopes that mirroring the care given by in-hospital physicians will produce better patient outcomes.

"While identical to techniques used by doctors in the hospital, intubation in these severe and stressful prehospital settings is very difficult and fraught with errors," said the study's lead author, Henry E. Wang, M.D., professor and vice chair for research in the Department of Emergency Medicine at McGovern Medical School at The University of Texas Health Science Center at Houston.

Today, however, new devices such as laryngeal tubes, offer simpler alternatives to opening and accessing an airway. These tubes are easier to use, and the trial showed that cardiac arrest patients treated with this alternative had a higher survival rate.

The findings from the study, the Pragmatic Airway Resuscitation Trial, were published online in the Journal of the American Medical Association.

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