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DZ𳾲13, 2024

Emergency Medical Service Agency Cardiac Arrest Practices—Reply

Author Affiliations
  • 1University of Texas-Southwestern Medical Center, Dallas
  • 2Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
JAMA Cardiol. Published online November 13, 2024. doi:10.1001/jamacardio.2024.3954

In Reply We agree with Dr Wang about the importance of airway management during resuscitation. In our survey of emergency medical service (EMS) agencies,1,2 we had included a question about airway management practices during resuscitation in the field. As can be seen in the Table, a higher proportion of EMS agencies in the top quartile of risk-standardized survival reported having available for their use a supraglottic airway and impedance threshold device. However, we did not include these variables for model consideration due to the following reasons. First, the survey question inquired about all available airway management strategies to an EMS agency, thus allowing for multiple selections. We did not specifically inquire about the agency’s first airway management strategy for patients in cardiac arrest. Thus, the categories are not mutually exclusive. Moreover, we also did not inquire how often and under what circumstances these airway options were used in practice. Second, we had included “alternative/blind airway insertion” as an option, which likely represents a supraglottic airway strategy. Lastly, several randomized clinical trials have not found improved survival outcomes in patients with cardiac arrest randomized to a supraglottic airway3 or an impedance threshold device.4 Because our airway management question lacked specificity and as these airway management devices were not found to be efficacious in randomized clinical trials, we chose to exclude this question from our analyses.

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