REVIVE airway study

The European Resuscitation Council (ERC) guidelines state that ‘There are no data supporting the routine use of any specific approach to airway management during cardiac arrest. The best technique is dependent on the precise circumstances of the cardiac arrest and the competence of the rescuer.’

In an editorial published in Resuscitation in 2009, entitled, ‘Airway Management for out-of-hospital cardiac arrest – more data required’, Nolan and Lockey confirmed that whilst tracheal intubation has been considered the gold standard for airway management during cardiac arrest, there is no high level evidence proving that tracheal intubation improves outcome. They also highlighted that virtually all data relating to the use of supraglottic airway devices (SADs) in cardiac arrest derive from low level studies, and concluded there is an urgent need for high-quality randomised controlled trials of the use of SADs for cardiopulmonary resuscitation (CPR).

The Airway Management Feasibility Study (REVIVE – Airways) is an attempt to start the process of providing just such evidence, by conducting a randomised comparison of the ventilation success of two 2nd generation supraglottic airways, i-gel® and the LMA Supreme®, in the initial airway management of out-of-hospital cardiac arrest (OHCA) compared to current practice, which is expected to be tracheal intubation. Clinical research in OHCA can be particularly difficult and is often an ethical challenge. Randomisation is not straightforward, so this study is of a cluster randomised design, whereby the randomisation is of the paramedic (as opposed to the patient) to one of the SADs or to ‘current practice’. This is a feasibility study, so the focus is on assessing how easy it is to recruit paramedics, and whether the study design will allow effective comparison of each of the three study arms. Secondary objectives include survival to hospital discharge. If the study does produce useful data, it is hoped this will lead to a national trial.

At the recent International Conference on Emergency Medicine (ICEM) in Dublin, the REVIVE Airway Working Group presented a poster confirming successful recruitment of 184 paramedics employed by Great Western Ambulance Service (GWAS) to the study. This exceeded their target of 150 – a recruitment of 35% of those eligible. The study is expected to end in February 2013. If the methodology proves successful, perhaps there is a chance we might see published data from a national study by 2016. That may seem a long time away, but it should be worth the wait.