Association of Prehospital Endotracheal Intubation With 28-Day Survival and Neurological Outcomes in Out-of-Hospital Cardiac Arrest
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 297
- Locations
- 1
- Primary Endpoint
- 28 day-survival rate
Study Overview
Brief Summary
This prospective observational study evaluated the association of prehospital endotracheal intubation (ETI) status with return of spontaneous circulation (ROSC), 28-day survival, and favorable neurological outcome in adult patients with out-of-hospital cardiac arrest (OHCA) transported to the emergency department (ED) by emergency medical services (EMS). In addition, the study investigated the causes of failed ETI attempts and examined other clinical factors associated with 28-day survival, including bystander cardiopulmonary resuscitation (CPR), initial cardiac rhythm, blood gas parameters, and prehospital airway management strategy.
Detailed Description
This prospective observational cohort study was conducted in the ED of Haseki Training and Research Hospital between July 1, 2025, and December 31, 2025. Patients presenting to the ED with cardiac arrest during the study period were screened for eligibility. All patients received advanced cardiac life support (ACLS) in accordance with the 2025 European Resuscitation Council (ERC) guidelines.
Data collected for each patient encompassed demographic characteristics (age, sex, and body mass index [BMI]) and comorbid conditions, including hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, and malignancy. Prehospital variables included witnessed arrest, bystander CPR, bystander automated external defibrillator (AED) use, no-flow duration, time from collapse to initiation of advanced life support (ALS), time from collapse to hospital arrival, hyperventilation, and initial cardiac rhythm (asystole/pulseless electrical activity [PEA] or ventricular fibrillation/pulseless ventricular tachycardia [VF/pVT]). Prehospital airway data were recorded in two ways: the airway device present on ED arrival (endotracheal tube in place, bag-valve-mask ventilation, or supraglottic airway) and prehospital ETI attempt status (successful ETI, failed ETI attempt, or no ETI attempt). ETI success and the reasons for failed ETI attempts were also recorded, as was the occurrence of prehospital ROSC.
Upon arrival at the ED, body temperature, Glasgow Coma Scale (GCS) score (when assessable), and vasopressor use within the first hour were recorded. Arterial blood gas parameters, including pH, partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2), were also documented. Clinical outcomes included ROSC, 28-day survival status, and neurological outcome.
Patients were classified as survivors or non-survivors according to 28-day survival status. Demographic characteristics, comorbidities, prehospital time intervals, initial rhythm, blood gas parameters, and airway management variables were compared across these groups to identify factors associated with 28-day survival. For airway-specific analyses, patients were further categorized into three groups according to ETI status: successful ETI, failed ETI attempt, and no ETI attempt. Comparisons among these groups were performed to assess differences in demographic and clinical characteristics, prehospital resuscitation variables, ROSC, 28-day survival, and favorable neurological outcome according to ETI status.
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Prospective
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age ≥18 years
- •Out-of-hospital cardiac arrest (OHCA)
- •Transport to the emergency department by emergency medical services (EMS)
- •Initiated resuscitation/advanced cardiovascular life support (ACLS) by EMS
- •Enrollment period between July 1, 2025, and December 31, 2025
Exclusion Criteria
- •Age <18 years
- •In-hospital cardiac arrest
- •Cardiac arrest due to major trauma, drowning, drug overdose, or known terminal illness
- •Tracheostomy present
- •Missing data on primary outcomes or admission laboratory parameters
Arms & Interventions
No ETI attempt
Adult patients with OHCA in whom no prehospital ETI attempt was performed by EMS personnel before arrival at the ED.
Intervention: Comorbidities (Other)
Survivors
Survivors were defined as the patient being alive at 28 days following the cardiac arrest event.
Intervention: Demographics (Other)
No ETI attempt
Adult patients with OHCA in whom no prehospital ETI attempt was performed by EMS personnel before arrival at the ED.
Intervention: 28-day survival (Other)
Survivors
Survivors were defined as the patient being alive at 28 days following the cardiac arrest event.
Intervention: Comorbidities (Other)
Failed ETI attempt
Adult patients with OHCA who underwent a failed prehospital ETI attempt by EMS personnel before arrival at the ED.
Intervention: Comorbidities (Other)
No ETI attempt
Adult patients with OHCA in whom no prehospital ETI attempt was performed by EMS personnel before arrival at the ED.
Intervention: Neurological outcome (Other)
Survivors
Survivors were defined as the patient being alive at 28 days following the cardiac arrest event.
Intervention: Prehospital Variables (Other)
Survivors
Survivors were defined as the patient being alive at 28 days following the cardiac arrest event.
Intervention: Arterial Blood Gas Parameters (Diagnostic Test)
Non-survivors
Non-survivors had passed away within 28 days following the cardiac arrest event.
Intervention: Demographics (Other)
Non-survivors
Non-survivors had passed away within 28 days following the cardiac arrest event.
Intervention: Comorbidities (Other)
Successful ETI
Adult patients with out-of-hospital cardiac arrest (OHCA) who underwent a successful prehospital endotracheal intubation (ETI) attempt by emergency medical services (EMS) personnel before arrival at the emergency department (ED).
Intervention: Neurological outcome (Other)
Failed ETI attempt
Adult patients with OHCA who underwent a failed prehospital ETI attempt by EMS personnel before arrival at the ED.
Intervention: Demographics (Other)
Non-survivors
Non-survivors had passed away within 28 days following the cardiac arrest event.
Intervention: Prehospital Variables (Other)
Non-survivors
Non-survivors had passed away within 28 days following the cardiac arrest event.
Intervention: Arterial Blood Gas Parameters (Diagnostic Test)
Successful ETI
Adult patients with out-of-hospital cardiac arrest (OHCA) who underwent a successful prehospital endotracheal intubation (ETI) attempt by emergency medical services (EMS) personnel before arrival at the emergency department (ED).
Intervention: Demographics (Other)
Successful ETI
Adult patients with out-of-hospital cardiac arrest (OHCA) who underwent a successful prehospital endotracheal intubation (ETI) attempt by emergency medical services (EMS) personnel before arrival at the emergency department (ED).
Intervention: Comorbidities (Other)
Successful ETI
Adult patients with out-of-hospital cardiac arrest (OHCA) who underwent a successful prehospital endotracheal intubation (ETI) attempt by emergency medical services (EMS) personnel before arrival at the emergency department (ED).
Intervention: Prehospital Variables (Other)
Successful ETI
Adult patients with out-of-hospital cardiac arrest (OHCA) who underwent a successful prehospital endotracheal intubation (ETI) attempt by emergency medical services (EMS) personnel before arrival at the emergency department (ED).
Intervention: Arterial Blood Gas Parameters (Diagnostic Test)
Successful ETI
Adult patients with out-of-hospital cardiac arrest (OHCA) who underwent a successful prehospital endotracheal intubation (ETI) attempt by emergency medical services (EMS) personnel before arrival at the emergency department (ED).
Intervention: 28-day survival (Other)
Failed ETI attempt
Adult patients with OHCA who underwent a failed prehospital ETI attempt by EMS personnel before arrival at the ED.
Intervention: Prehospital Variables (Other)
Failed ETI attempt
Adult patients with OHCA who underwent a failed prehospital ETI attempt by EMS personnel before arrival at the ED.
Intervention: Arterial Blood Gas Parameters (Diagnostic Test)
Failed ETI attempt
Adult patients with OHCA who underwent a failed prehospital ETI attempt by EMS personnel before arrival at the ED.
Intervention: 28-day survival (Other)
Failed ETI attempt
Adult patients with OHCA who underwent a failed prehospital ETI attempt by EMS personnel before arrival at the ED.
Intervention: Neurological outcome (Other)
No ETI attempt
Adult patients with OHCA in whom no prehospital ETI attempt was performed by EMS personnel before arrival at the ED.
Intervention: Demographics (Other)
No ETI attempt
Adult patients with OHCA in whom no prehospital ETI attempt was performed by EMS personnel before arrival at the ED.
Intervention: Prehospital Variables (Other)
No ETI attempt
Adult patients with OHCA in whom no prehospital ETI attempt was performed by EMS personnel before arrival at the ED.
Intervention: Arterial Blood Gas Parameters (Diagnostic Test)
Outcomes
Primary Outcomes
28 day-survival rate
Time Frame: At 28 days after ACLS initiation following OHCA.
Survival status at day 28 after advanced cardiovascular life support (ACLS) initiated following out-of-hospital cardiac arrest (OHCA). Participants will be classified as survivors if alive on day 28 and as non-survivors if death occurs within 28 days.
Secondary Outcomes
- Neurological Status at 28 Days(At 28 days after ACLS initiation following OHCA)
- Achievement of Return of Spontaneous Circulation (ROSC) During Resuscitation Following Out-of-Hospital Cardiac Arrest (OHCA).(Assessed within the first 20 minutes after emergency department admission.)
- Comparison of 28-Day Survival Rates Between Participants Who Underwent Prehospital Endotracheal Intubation and Those Who Did Not(At 28 days after ACLS initiation following OHCA)
Investigators
Adem Az
Principal Investigator
Haseki Training and Research Hospital