Raising the Intubation Bar is Noble, But Not Practical

We thank Mr. Wood and Mr. Podsialdo for their insightful comments regarding the Pragmatic Airway Resuscitation Trial (PART) results.  With regards to their comment of prior studies finding better outcomes with intubation than supraglottic airways, one must bear in mind that these prior studies were biased by their retrospective designs; the airway was selected by paramedic choice and may have been influenced by a range of factors such as the patient’s condition, anatomy, the physical environment or the practitioner’s level of comfort. Meta-analysis or systematic reviews of these retrospective studies also unfortunately suffer from these same limitations primarily related to confounding by indication.1 Randomization is the only way to overcome these biases. PART is one of the first prospective randomized studies to compare airway strategies in adults with out-of-hospital cardiac arrest. Therefore, it’s not surprising that a randomized study such as PART found a result completely opposite to prior studies based upon retrospective observational data. History has many examples of ineffective EMS interventions being disproven by randomized trials; examples include the use of MAST trousers in trauma, early fluid resuscitation in penetrating torso trauma and prehospital induction of mild hypothermia in out-of-hospital cardiac arrest (OHCA).2–4 The 3% difference in survival seen in the PART study is a very important finding when you consider that OHCA affects nearly...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Source Type: news