Survival outcomes following prehospital intubation in nontraumatic out of hospital cardiac arrest in Bangkok Thailand

Out of hospital cardiac arrest (OHCA) is one of the most challenging medical emergencies in pre-hospital care. Airway management plays an important role in resuscitation with endotracheal intubation (ETI) and bag-valve-mask (BVM) being the most common methods. Currently, there is no standardized protocol airway management in non-traumatic OHCA established with inconclusive evidence. This study aims to demonstrate superiority of ETI in survival outcomes of non-traumatic OHCA. This retrospective observational cohort study was conducted at the Emergency Medical Services (EMS) Center, Bangkok Metropolitan Administration over a 5-year period, between January 2019 to December 2023. The record of non-traumatic OHCA adult patients who received EMS were analysed, including airway methods (ETI and BVM) received during resuscitation. The primary outcome was survival to emergency department (ED) admission, at scene and hospital discharge. Out of 13,633 patients with non-traumatic OHCA, 5,341 patients met the eligibility criteria. Among them, 2482 (46.5%) received ETI, while 2857 (53.5%) were managed with BVM ventilation. ETI was associated with a 22% increase in the likelihood of return of spontaneous circulation (ROSC) at the scene (95% CI 19–25, P < 0.001), 6% increase in the likelihood of survival to hospital ED admission (95% CI 5–8, P < 0.001) and 1% increase in the likelihood of survival to hospital discharge (95% CI 0–2, P = 0.003). In non-traumatic OHCA, ETI was associated with higher survival outcomes compared to BVM, including survival to hospital admission, ROSC at the scene, and survival to hospital discharge. Future studies should employ prospective designs, address provider-level and patient-level differences, and implement system-wide quality improvement and standardized airway training to reduce practice variability and optimize prehospital airway management in OHCA.