Airway Management in cardiac arrest patients (AIRWAYS-2)
Research type
Research Study
Full title
Cluster randomised trial of the clinical and cost effectiveness of the i-gel supraglottic airway device versus tracheal intubation in the initial airway management of out of hospital cardiac arrest
IRAS ID
159391
Contact name
Jonathan Benger
Contact email
Sponsor organisation
South Western Ambulance Service NHS
ISRCTN Number
ISRCTN08256118
Research summary
Cardiac arrest occurs when the heart beat and breathing stop suddenly and is one of the most extreme medical emergencies. Health outcomes are poor; 90% of patients die at the scene or before discharge from hospital. The best initial treatment is cardiopulmonary resuscitation (CPR); a combination of rescue breathing and chest compressions. Prompt and effective CPR prevents damage to the brain and other organs, and maximises the chance that the heart will start beating again.
Ensuring a clear airway, whilst interrupting chest compressions as little as possible, is essential for survival. At the moment, we do not know the best way for NHS ambulance staff to provide rescue breathing during a cardiac arrest (out of hospital cardiac arrest: OHCA). Placing a breathing tube in the windpipe (intubation) has been considered the best method. However, attempting to place the breathing tube can cause significant complications as well as interruptions in chest compressions.
National recommendations suggest using a newer method: insertion of a supraglottic airway device (SAD); a tube that sits on top of the voice box. SADs are already used during routine anaesthesia in hospital; in emergency care, they are quicker to insert and cause less interruption to chest compressions. However, a SAD does not stay in place as securely as a breathing tube and, if a patient vomits, stomach contents may get into their lungs.
There is real uncertainty amongst paramedics and experts in the field about the best method to ensure a clear airway during the early stages of OHCA. We therefore propose to undertake a large research study to determine whether intubation or the best available SAD (called the i-gel) gives the best chance of recovery following OHCA. The study will be a randomised controlled trial (RCT) in four English NHS ambulance services. It will recruit adult OHCA patients who have suffered a cardiac arrest that is not due to injury. Paramedics who agree to take part will be divided into two groups and given structured education on CPR and rescue breathing. One group will be required to use the i-gel and the other intubation as the first method of rescue breathing in all cases of OHCA that they attend during the study.
We will follow-up the patients in hospital, and 3 and 6 months later, to find out the quality of life of survivors and the NHS resources used during their hospital stay and subsequently.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
14/SC/1219
Date of REC Opinion
24 Sep 2014
REC opinion
Further Information Favourable Opinion