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EMS agencies perform intubations to help restore breathing to cardiac arrest patients. New studies show patients fare as well or better with less-invasive alternatives.
As Rhode Island confronts the risks associated with EMS personnel inserting breathing tubes in cardiac arrest patients, new studies suggest that the practice should be limited outside hospitals.
Two separate studies published last year, one in the United States and one in the United Kingdom, offer fresh evidence that patients fare at least as well, if not better, when emergency medical services workers opted for alternatives to intubating.
One study of about 3,000 cardiac arrest patients in the U.S. found that these adults had a “significantly greater” chance of surviving 72 hours if the EMS providers used a less-invasive “laryngeal tube” to help them breathe, compared with those who had an endotracheal intubation. During an intubation, a tube is inserted through the mouth and visually guided down into the trachea, to deliver oxygen to the lungs. But if the tube is misplaced, it can accidentally wind up in the patient’s esophagus, blowing air into the stomach. By contrast, a laryngeal tube, often referred to as a “King Tube,” is fitted with two inflatable balloons, one blocking the opening to the esophagus, to ensure that the oxygen is directed into the lungs.
Patients treated with less-invasive breathing devices, the study found, also had a higher rate of good neurological outcomes compared with those who were intubated.
Another study of about 9,000 cardiac arrest patients in England found no difference in patients’ conditions after 30 days between those who had been intubated and those treated with the less-invasive devices.
The American Heart Association now recommends that EMS agencies opt for alternative devices if they have minimal training in properly placing those tubes or if they have a low percentage of providers who can successfully insert the tube into the trachea on the “first pass.”