Post-resuscitation pre-hospital emergency anaesthesia for exchange of a supraglottic airway device with an endotracheal tube - a multicentre observational study.

Authors

Jonas Bökamp, Eugen Latka, Michael Bernhard, Martin Deicke, Daniel Fischer, Julia Grannemann, Jochen Hinkelbein, Yacin Keller, Annika Hoyer, André Kobiella, Lydia Johnson Kolaparambil Varghese, Bernd Strickmann, Mathini Vaseekaran, Vera Von Dossow, Gerrit Jansen

Published in

BMC emergency medicine. Volume 26. Issue 1. Jul 13, 2026. Epub Jul 13, 2026.

Abstract

Post-resuscitation pre-hospital emergency anaesthesia (PHEA) for changing a supraglottic airway device (SGA) to an endotracheal tube (ETT) after out-of-hospital cardiac arrest may improve airway management but carries potential risks, particularly related to haemodynamic instability. This study investigates its association with complications during post-resuscitation care.
All Emergency Medical Service missions in the districts Gütersloh, Dresden and Lippe from 2019 to 2021 were analysed for out-of-hospital cardiac arrest and supplemented with data from the German Resuscitation Register. Unconscious adult, pre-hospitally resuscitated patients who had an SGA changed to an ETT following pre-hospital return of spontaneous circulation and who had spontaneous circulation on admission to hospital were included. We compared patients with and without PHEA. The primary endpoint was the occurrence of haemodynamic complications during post-resuscitation therapy, defined as re-arrest, hypotension or antihypotensive therapy. For statistical analysis, propensity score matching was performed adjusting for age, sex, pre-existing disease, shockable initial cardiac rhythm, bystander CPR and witnessed arrest.
Of 2,305 cardiac arrest patients in 391,305 Emergency Medical Service missions, 706 (30.6%) had return of spontaneous circulation and 202 met our inclusion criteria. 126 of those patients (62.4%) received PHEA to facilitate changing an SGA to an ETT. The propensity score analysis showed no evidence for differences in the odds of occurrence of at least one haemodynamic complication (OR=1.50 [95% CI=0.72-3.11; p=0.28]), airway complication (OR=1.00 [95% CI=0.25-4.00; p=1.00]), re-arrest (OR=0.39 [95% CI=0.14-1.08; p=0.07]), hypotension (OR=1.39 [95% CI=0.68-2.83; p=0.37]) or antihypotensive therapy (OR=1.58 [95% CI=0.77-3.26; p=0.21]) between patients having their SGA changed to an ETT following PHEA compared to patients who had their SGA changed to an ETT without PHEA.
The study provided no statistical evidence for increased odds of complications associated with the delivery or omission of pre-hospital emergency anaesthesia during exchange from a supraglottic airway device to an endotracheal tube in resuscitated out-of-hospital cardiac arrest patients.
Not applicable.

PMID:
42443769
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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