This suggests that selection bias by the EMS providers might account for some of the differences observed in this study. Second, this was not a randomized controlled selleck chem trial and although we adjusted for confounding factors in the multivariable analysis, other unknown confounding factors might exist which could have affected our results. Third, we did not obtain data on the CPR quality (compression rate, compression depth, CPR fraction and ventilation rate) of the EMS providers and did not monitor EMS CPR process data. However, the EMS system was generally uniform in this study area [14] and it is unlikely that a difference in CPR quality would account for the differences between the two groups. Fourth, we have no data on the quality of advanced airway management by the individual ELST.

It is possible that the ELST’s performance status (intubation frequency, chest compression interruption periods, and intubation success rate) may have influenced the outcomes after OHCA [21,22]. Fifth, information on the new CPR guidelines during the study period might affect the relationship between advanced airway management and the outcome. Sixth, as with all multi-site epidemiological studies, data integrity, validity and ascertainment bias are potential limitations. The uniform data collection, consistent definitions, time synchronization process and large sample size in this population-based cohort study were intended to minimize these potential sources of bias.ConclusionsDespite a longer time interval for collapse to airway placement for ETI compared to SGA, the devices are equally effective for on-site out-of-hospital airway management after OHCA.

In patients who received an advanced airway, early advanced airway placement — regardless of device and rhythm — is associated with improved outcomes in OCHA patients, as is ETI certification for attending ELSTs.Key messages? The intervention time (from collapse to advanced airway placement) was significantly longer in the ETI group compared to the SGA group (17.2 minutes versus 15.8 minutes, P < 0.001).? One-month survival with favorable neurological outcome was not different between the ETI and SGA groups (3.6% versus 3.6%, P = 0.945).? The presence of an ETI-certified ELST was a significant predictor of a favorable outcome (adjusted OR, 0.91; 95% CI 0.88 to 0.95; P < 0.011, adjusted OR, 1.86; 95% CI 1.04 to 3.

34, P < 0.01; respectively).? The proportion of favorable neurological outcomes among OHCA patients with advanced airway management decreased as time-to-placement increased: 5.7% in Q1, 4.6% in Q2, 3.1% in Q3, and 1.4% in Q4. (Q1: ��10 minutes, Q2: 11 to 14 minutes, Q3: 15 to 19 minutes, Q4: ��20 minutes).? In patients who received an advanced airway, Dacomitinib early advanced airway placement-regardless of device and rhythm is associated with improved outcomes in OCHA patients, as is ETI certification for attending ELSTs.