6/29/23, 1:34 AM PART Pathway Feedback Search Clinical Topics Home Studies PART PART Disease Cardiac arrest Trial question What is the effect of a strategy of initial laryngeal tube insertion among adults with out-of-hospital cardiac arrest? Study design Multi-center Open label RCT Population Characteristics of study participants 39.0% female N = 3004 61.0% male 3004 patients (1175 female, 1829 male) Inclusion criteria: adults with out-of-hospital cardiac arrest and an anticipated need for advanced airway management Key exclusion criteria: advanced airway device inserted prior to participation, pre-existing tracheostomy, asphyxial cardiac arrest, LV assist device, or total artificial heart Interventions N=1505 laryngeal tube (insertion of a supraglottic airway as an initial airway management strategy) N=1499 endotracheal intubation (insertion of a plastic breathing tube through the mouth and into the trachea as initial airway management strategy) https://web.pathway.md/studies/recE01UbX5vsR1ofi 1/2 6/29/23, 1:34 AM PART Pathway Primary outcome Survival to 72 hour 18.3 % 18.3 15.4 13.7 % 9.2 % Significant increase 4.6 % NNT = 34 0.0 % Laryngeal tube Endotracheal intubation Significant increase in survival to 72 hour (18.3% vs. 15.4%; AD 2.9%, 95% CI 0.2 to 5.6) Secondary outcomes Significant increase in ROSC on emergency department arrival (27.9% vs. 24.3%; AD 3.6%, 95% CI 0.3 to 6.8) Significant increase in survival to hospital discharge (10.8% vs. 8.1%; AD 2.7%, 95% CI 0.6 to 4.8) Significant increase in favorable neurologic status at discharge, mRS score 3 (7.1% vs. 5%; AD 2.1%, 95% CI 0.3 to 3.8) Safety outcomes No significant differences in oropharyngeal or hypopharyngeal injury, airway swelling, pneumonia, aspiration pneumonitis. Significant differences in airway insertion attempts (4.5% vs. 18.9%), unsuccessful initial airway insertion (11.8% vs. 44.1%), pneumothoraces (3.5% vs. 7.0%), rib fractures (3.3% vs. 7.0%). Conclusion In adults with out-of-hospital cardiac arrest and an anticipated need for advanced airway management, laryngeal tube was superior to endotracheal intubation with respect to survival to 72 hour. Reference Henry E Wang, Robert H Schmicker, Mohamud R Daya et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018 Aug 28;320(8):769-778. Open reference URL https://web.pathway.md/studies/recE01UbX5vsR1ofi 2/2