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Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Kentaro Kajino1*, Taku Iwami2, Tetsuhisa Kitamura2, Mohamud Daya3, Marcus Eng Hock Ong4, Tatsuya Nishiuchi5, Yasuyuki Hayashi6, Tomohiko Sakai7, Takeshi Shimazu8, Atsushi Hiraide9, Masashi Kishi1 and Shigeru Yamayoshi1

Author Affiliations

1 Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31 Kitayama-cho Tennouji-ku, Osaka 543-0035, Japan

2 Kyoto University, Health Services, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan

3 Department of Emergency Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, mail code CR-114, Portland, OR 97239-3098, USA

4 Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore

5 Department of Critical Care and Emergency Medicine, Osaka City University Graduate School of Medicine, 1-5-17 Asahimachi, Abeno-ku, Osaka 545-8585, Japan

6 Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1 D5, Tsukumodai, Suita, Osaka 565-0862, Japan

7 Department of Trauma and Critical Care Medicine and Burn Centers, Social Insurance Chukyo Hospital, 1-1-10 Sanjyo Minami-ku, Nagoya, Aichi 457-8510, Japan

8 Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of medicine, 2-15 Yamada-Oka, Suita City, Osaka 565-0871, Japan

9 ER Medicine, Kinki University Faculty of Medicine, 377-2 Ouno higashi Osaka-Sayama, Osaka 589-8511, Japan

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Critical Care 2011, 15:R236  doi:10.1186/cc10483

See related commentary by Morley,

Published: 10 October 2011



Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.


All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.


Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P < 0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.


There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.

cardiac arrest; endotracheal intubation; Supraglottic airway; advanced airway; pre-hospital; resuscitation