EBQ:Japanese OHCA Prehospital Airway Management Trial - Revision history

Danbot: Added Study Design section

2026-03-21T22:40:44Z

Added Study Design section

← Older revision		Revision as of 22:40, 21 March 2026
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	**This negative association cannot prove causality		**This negative association cannot prove causality
	*Regression models using Propensity matched patients favored BVM when compared to both endotracheal intubation and supraglottic airway management in terms of obtaining ROSC prior to arrival at the hospital, 1-month survival, and neurologically favorable survival		*Regression models using Propensity matched patients favored BVM when compared to both endotracheal intubation and supraglottic airway management in terms of obtaining ROSC prior to arrival at the hospital, 1-month survival, and neurologically favorable survival

			==Study Design==
			*Prospective, population-based, observational study using the All-Japan Utstein Registry
			*Nationwide Japanese emergency medical services (EMS) data
			*N = 649,654 adult OHCA patients
			*Study period: January 2005 - December 2010
			*Primary Outcome: 1-month survival with favorable neurological outcome (CPC 1 or 2)

	==Inclusion Criteria==		==Inclusion Criteria==

2026-03-21T22:11:25Z

Mark as Complete - article has all required sections

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	\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=1557712		\| fulltexturl= http://jama.jamanetwork.com/article.aspx?articleid=1557712
	\| pdfurl= http://jama.jamanetwork.com/data/Journals/JAMA/926246/jce120008_257_266.pdf		\| pdfurl= http://jama.jamanetwork.com/data/Journals/JAMA/926246/jce120008_257_266.pdf
			\| status = Complete
	}}		}}

2019-10-14T18:06:08Z

Interventions

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	**Endotracheal intubation		**Endotracheal intubation
	**Supraglottic airway		**Supraglottic airway
			**EMTs able to place advanced airway had received specialized training as quoted in the paper [http://www%20.mhlw.go.jp/shingi/2009/03/dl/s0325-12g_0001.pdf. here]<ref>Ambulance Service Planning Office of Fire and Disaster Management Agency of Japan. Airway Management With Endotracheal Intubation by Emergency Life Saving Technicians. 2004. http://www.mhlw.go.jp/shingi/2009/03/dl/s0325-12g_0001.pdf.</ref>
	***Laryngeal mask airway, laryngeal tube, or esophageal-tracheal twin lumen airway device		***Laryngeal mask airway, laryngeal tube, or esophageal-tracheal twin lumen airway device
	*Providers had 2 attempts to place airway device		*Providers had 2 attempts to place airway device

2019-10-14T18:00:25Z

Major Points

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	*Advanced airway of any type was independently associated with decreased odds of neurologically favorable survival compared to BVM ventilation		*Advanced airway of any type was independently associated with decreased odds of neurologically favorable survival compared to BVM ventilation

	==Major Points==		==Major Points==
			*Advanced airway management during OHCA and CPR was independently associated with a decreased likelihood of favorable neurological outcome when compared to BVM management
			**This negative association cannot prove causality
			*Regression models using Propensity matched patients favored BVM when compared to both endotracheal intubation and supraglottic airway management in terms of obtaining ROSC prior to arrival at the hospital, 1-month survival, and neurologically favorable survival

	==Inclusion Criteria==		==Inclusion Criteria==

2019-10-14T17:48:28Z

Criticisms

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	*Not a randomized and there is potential selection bias and confounding		*Not a randomized and there is potential selection bias and confounding
	*Generalization difficult for U.S. based EMS given different training for EMT's, different population, and different protocols		*Generalization difficult for U.S. based EMS given different training for EMT's, different population, and different protocols
			*Details regarding the process of information were not available
			*It is possible that patients who received BVM only had ROSC sooner and therefore did not require advanced airway management
			**It can be theorized that this subset of patients would have better neurological outcomes

	==Funding==		==Funding==

2019-10-14T15:53:30Z

Funding

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	==Funding==		==Funding==
			*Grant support to Dr. Hiraide for emergency management scientific research from the Fire and Disaster Management Agency.
			*The Fire and Disaster Management Agency gathered and managed the data but had no role in the design and conduct of the study; analysis and interpretation of the data; or preparation, review, or approval of the manuscript.

	==References==		==References==

2019-10-14T15:50:36Z

Secondary Outcomes

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	***Endotracheal Intubation: 8.4%		***Endotracheal Intubation: 8.4%
	***Supraglottic Airway: 5.3%		***Supraglottic Airway: 5.3%
			** Odds ratio (95% CI) Advanced Airway vs BVM: 0.81 (0.79-0.83)
	*One-month survival		*One-month survival
	**Overall 4.7%		**Overall 4.7%
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	***Endotracheal Intubation: 4.2%		***Endotracheal Intubation: 4.2%
	***Supraglottic Airway: 3.8%		***Supraglottic Airway: 3.8%
			** Odds ratio (95% CI) Advanced Airway vs BVM: 0.72 (0.70-0.73)

	===Subgroup analysis===		===Subgroup analysis===

2019-10-14T15:45:35Z

Primary Outcomes

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	*Favorable neurological outcome at 1 month after cardiac arrest		*Favorable neurological outcome at 1 month after cardiac arrest
	**Favorable neurological outcome considered a Glasgow-Pittsburgh cerebral performance category of 1 or 2		**Favorable neurological outcome considered a Glasgow-Pittsburgh cerebral performance category of 1 or 2
			**Overall: 2.2%
			**BVM: 2.9%
			**Advanced Airway: 1.1%
			***Endotracheal Intubation: 1.0%
			***Supraglottic Airway: 1.1%
			**Odds Ratio (95% CI) Advanced Airway vs. BVM: 0.38 (0.36-0.39)
	*Glasgow-Pittsburgh cerebral performance categories:		*Glasgow-Pittsburgh cerebral performance categories:
	**Category 1 (good performance)		**Category 1 (good performance)

2019-10-14T15:38:30Z

Criticisms

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	==Criticisms==		==Criticisms==
	*Not a randomized and there is potential selection bias and confounding		*Not a randomized and there is potential selection bias and confounding
			*Generalization difficult for U.S. based EMS given different training for EMT's, different population, and different protocols

	==Funding==		==Funding==

2019-10-14T15:35:28Z

Secondary Outcomes

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	===Secondary Outcomes===		===Secondary Outcomes===
	*Return of spontaneous circulation before hospital ~~arrive~~		*Return of spontaneous circulation before hospital arrival
	*1 month survival		**Overall: 6.5%
			**BVM: 7.0%
			**Advanced Airway: 5.8%
			***Endotracheal Intubation: 8.4%
			***Supraglottic Airway: 5.3%
			*One-month survival
			**Overall 4.7%
			**BVM: 5.3%
			**Advanced Airway: 3.9%
			***Endotracheal Intubation: 4.2%
			***Supraglottic Airway: 3.8%

	===Subgroup analysis===		===Subgroup analysis===