Intubation vs BVM in out of hospital cardiac arrest

[paramedicmike]

We've talked about this at length here before.  Saw this and thought it was was worth a mention.

 

Link.

[cekuriger]

Well, it should never be advanced airway management vs providing ventilation...Unless, what you meant was, intubate, or just do BLS airways. 

This question isn't really a one word answer, and can get kind of complicated. 

Text book answers say, Intubation is the Gold Standard. Reason being, you can prevent gastric insufflation, which as we all know could lead to an airway disaster, and just general aspiration of secretions, and the text books are very correct in saying that.

But. Text books, again, as I'm sure you know (I'm not trying to be condescending), often ignore the reality of the streets; it's not uncommon that the situation simply doesn't allow you to. 

Also, you need to look at the cause of arrest. Was it primarily airway related? Then, yes, do everything you freaking can to get that tube. 

Or, do we suspect it's more cardiac in nature, where you still have some O2 reserve to play around with?

Either way, if you can't get a tube for some reason, there's no reason why an ALS provider shouldn't at least have a king airway (or whatever ALS Adjunct is preferred in whatever state). Most adjuncts have SOME degree of airway protection. Very little, and close to none, but it's better than just "hoping for the best".

A king airway takes basically no skill, and there's no reason why it can't be in every state's BLS Scope of Practice. 

If for some reason, I see an ALS provider only doing BLS airways on an arrest...they aren't technically wrong, but I'll still stand there and roll my eyes unless they have a VERY good reason why 

 

 

[paramedicmike]

58 minutes ago, cekuriger said:

Unless, what you meant was, intubate, or just do BLS airways. 

 

 

 

Unless, what I meant by actually posting a link to the study, was that you read it.  The study looks at outcomes.  Take a few minutes to review the abstract.  Not entirely sure where you're coming up with the things on which you're commenting.

[rock_shoes]

This particular study tells us absolutely nothing about inferiority/superiority. I don't see any confounding factors accounted for such as intubator skill level or cause of arrest, nor does the study have sufficient overall numbers to draw any conclusions. The study arms are broken in to "initial management with ETI" and "initial management with BVM". What's the time scale here? Does initial management with BVM mean the first 10 minutes of the arrest or the entire arrest management period? Does initial management with ETI mean at some point early on when other more important interventions have already been started or essentially when the crew first walks in the door?

 

This study leaves far more questions about it's own validity than it does about the harm vs. benefit of early ETI in cardiac arrest.

[Off Label]

What are we supposed to get from an abstract? I couldn't read the whole study so all I can say is that the authors are saying that mask ventilation isn't inferior to intubation. Unless someone has passed the pay wall for this journal, no one else can make any coherent statement either. "Not inferior" is being used as a  a statistical term here and does not have the same significance as a conversational "just as good".

Abstracts are useless, really.