Journal Club
November Journal Club

November 18 (Thursday)
6:30 PM
5510 Cramblet Hall Conference Room

Journal Club Vignette

You have recently taken over as the medical director for a small suburban EMS system. As such, you are responsible for evaluating and developing the protocols for your squads. The AHA guidelines have recently been published with a new emphasis on C-A-B rather than A-B-C. As such, the new ACLS algorithm puts further emphasis on high quality chest compressions and the use of an advanced airway is now to be "considered" after initiation of CPR. In light of these changes, your paramedics ask you if there will be any changes to their protocol with regards to out of hospital cardiac arrest (OHCA) and intubation, as many of them consider this the hallmark of what it means to be a paramedic.

To investigate this, the following approach is explored:

PICO Question

Population: OHCA
Intervention: Endotracheal Intubation
Comparison: Bag Valve Mask/No Intubation
Outcome: Survival to Discharge, ROSC, Admit to Hospital


Search Strategy: Pubmed; Keywords: Endotracheal Intubation AND prehospital AND cardiac arrest Results: 100 articles. 3 selected for review:
First years: Advanced airway management does not improve outcome of out-of-hospital cardiac arrest: Hanif et al. (Pub Med Link) Acad Emerg Med Sept 2010.

Article Critique
Second years: The association between prehospital endotracheal intubation attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients: Studnek et al. (Pub Med Link) Acad Emerg Med Sept 2010.

Article Critique
Third years: Assessing the Impact of Prehospital Intubation on Survival in Out-of-Hospital Cardiac Arrest: Egly et al. (Pub Med Link) Prehosp Emer Care Sep 2010

Article Critique
All years use the "Observational Study Critical Review Form" (Download)


Extra Articles: Emergency intubation for acutely ill and injured patients (Review): Lecky, et. al. The Cochrane Collaboration 2009.

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Effect of emergency medical technician-placed combitubes on outcomes after out-of-hospital cardiopulmonary arrest: Cady, et. al. Prehosp Emer Care 2009;13:495-9.

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© Ohio State University Department of Emergency Medicine