More evidence for BVM only in OHCA…a study from Japan.
My thoughts: – the data supporting intra-arrest advanced airway management is looking pretty thin on the ground. The Japanese model of prehospital care is not similar to Australasian PHC models. Again, I don’t necessarily think that this study can be used as a basis for change to worldwide prehospital practice.
For example, for prehospital services that provide prehospital therapeutic cooling, ETI is essential. So I guess the question is, should such services consider BVM during arrest, and if ROSC is achieved, RSI or “cold tube” and then sedate/paralyse/cool? As far as I know, there aren’t many studies looking at advanced airway Mx in the ROSC/cooling component of overall OHCA management. The authors acknowledge that it is difficult to establish a link to prehospital advanced airway management and poor outcomes.
Anyway, this is a well designed study out of Japan. Have a look.
Hey Ben, any studies you know of that discuss the time taken to perform the intubation process, therefore “Hands off the chest time”. potentially a key here. Quick search and I answered my own question, Wang 2008, Interruptions in Cardiopulmonary Resuscitation From Paramedic Endotracheal Intubations, found up to 1 min interruptions. I would like to suppose that the quality of training in intubation provided to the pre-hospital provider would have an impact here. Tim
Wang et al study a worry Tim. Use it in MICA lecture as the attempt ranged from 2 to 9 (!!!) in that study. Not reflective of our practice. So I agree that it’s dependent in education and training