To Intubate or Not to Intubate (During In-Hospital Cardiac Arrest), that Is the Question

 

Today we discuss a paper from Lars Anderson:

Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival

You can find a direct link to the article here:

Observational studies DO have value. Don’t be an RCT snob!

Observational studies allow us to:

  1. Identify associations (not necessarily implying causation)

  2. Question our current practice

  3. Study things that may otherwise be unethical or logistically unfeasible

Remember to always look at Figure 1 in an observational study. It contains useful information on how patients were selected and/or excluded from the data. Here's the Figure 1 from the study.

Surprisingly, many of our patients would be excluded from some of the major RCTs we've grown to love. What implications does this have on utilizing this study data to care for our patients?

Two small observational studies on in-hospital resuscitation

https://www.ncbi.nlm.nih.gov/pubmed/2174183

https://www.ncbi.nlm.nih.gov/pubmed/11485508

 

Japanese larger observational study (prehospital)

https://jamanetwork.com/journals/jama/fullarticle/1557712

 

Korean larger observational study (prehospital)

https://www.ncbi.nlm.nih.gov/pubmed/26597496

 

Our final take - where does this leave us?

  • We aren’t ready to completely abandon intubation during cardiac arrest based on the results of this study alone.

  • There is no evidence that you should STOP someone from intubating during a cardiac arrest if they are already trying.

  • We are personally more inclined to use LMA during cardiac arrest given it’s simplicity, speed of insertion and ability to run quantitative EtCO2 & continuous chest compressions.

  • DO NOT stop chest compressions to intubate the patient. If you are having difficulty intubating without stopping chest compressions, you should probably just put in an LMA.

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