Source Article | Courtesy of Matt Zavadsky
Nice article in JEMS that boils down the results of the PART study into understandable, and potentially actionable bites.
Key statement(s) from the authors:
The trial began enrollment on Dec. 1, 2015, and completed enrollment on Nov. 4, 2017. A total of 3,004 subjects were enrolled, with 1,505 assigned to initial King LT and 1,499 assigned to initial ETI. Patient demographics and arrest characteristics were similar in both groups.
Elapsed time from first EMS arrival to airway start was shorter for King LT than ETI (mean 11.0 mins. vs. 13.6 mins.). Initial airway success rate was 89.9% in the King LT group and 51.3% in the ETI group. Overall, the King LT and ETI airway success rates (initial plus rescue airway attempts) were 94.2% and 91.5%, respectively. The ETI group was more likely to require more than three insertion attempts (18.9% vs. 4.5%).
The main outcome of the study, 72-hour survival, was significantly higher for King LT than ETI (18.3% vs. 15.4%), a difference of 2.9%. Secondary outcomes were also better for King LT than ETI including: ROSC (27.9% vs. 24.3%), hospital survival (10.8% vs. 8.1%), and favorable neurological status at discharge (7.1% vs. 5.0%).
The ETI group had higher rates of multiple airway insertion attempts, unsuccessful airway insertion, and unrecognized airway misplacement or dislodgement. Other in-hospital adverse events were similar between treatment groups.
What It Means
In this trial of 3,004 adults, we found that a strategy of initial King LT resulted in better 72-hour survival than initial ETI. Initial King LT also had better outcomes including ROSC, survival to hospital discharge, and favorable neurologic status at hospital discharge. Although these differences seem small, they’re important.
If all EMS systems across the country were to shift to King LT as the primary advanced airway for OHCA patients and saw a similar 2.7% increase in hospital survival rate, more than 10,000 extra lives would be saved each year.
ETI vs. SGA: The Verdict Is In
A field guide to the results of the Pragmatic Airway Resuscitation Trial (PART)
Thu, Aug 30, 2018
By Shannon W. Stephens, EMT-P , Henry E. Wang, MD, MS , Pam Gray, EMT-P , Randal Gray, MEd, BS, EMT-P , Linda Mattrisch, BS, EMT-P , Ahamed H. Idris, MD , Mohamud Daya, MD, MS
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