Sarah E Maessena,2, Pablo Callejasa, Andy Swaina,3, Bridget Dickera,2
1Clinical Evaluation, Research, and Insights, Hato Hone St John New Zealand, Auckland, New Zealand;
2Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand;
3Wellington Free Ambulance, Wellington, New Zealand.
Biography:
Abstract:
Purpose
Nearly three-quarters of endotracheal intubations (ETI) performed by Aotearoa New Zealand’s ambulance services in 2020/2021 occurred in cardiac arrest, with a first-pass success rate of only 65.2%. This study updates these findings using the national out-of-hospital airway registry.
Methodology
Adult OHCA incidents between August 2023-July 2024 of presumed cardiac aetiology with a resuscitation attempt were included if a supraglottal airway device (SGA) or ETI were used. Incident characteristics were compared between patients with or without an ETI attempt using chi square or independent samples t-test. Success rates were calculated for any successful airway placement and first-pass success.
Results
A total of 1692 OHCA events were identified. Patient and incident characteristics aligned with national OHCA statistics, predominantly involving males, arrests at home, and urban areas. SGA was attempted in 1,301 patients, with an 89.4% success rate. ETI attempts were more common in patients with a bystander resuscitation attempt or a shockable rhythm (p<.001). ETI was successful in 94.8% of cases, with first pass success rates of 88.4% for drug-assisted ETI (n=138) and 77.2% for non-drug-assisted ETI (n=803).
Conclusion
Since the initial 2020/2021 report, the proportion of cardiac arrest patients undergoing ETI remained similar. Overall and first pass success rates have notably improved, but appear to remain lower than those in a non-OHCA setting. The improvement is likely due to enhanced training, better monitoring, and increased use of video laryngoscopy. Drug-assisted ETI continues to be more successful.