Table 1.
Characteristic | PART | AIRWAYS‐2 | CAAM |
---|---|---|---|
Setting | United States | United Kingdom | France, Belgium |
Patients | Adult (≥18 years) OHCA requiring BVM or advanced airway management | All adult (≥18 years) OHCA | All adult (≥18 years) OHCA |
Comparisons | Laryngeal tube versus endotracheal intubation | i‐gel versus endotracheal intubation | Bag‐valve‐mask ventilation versus endotracheal intubation |
Practitioners | Paramedics, select emergency medical technicians | Paramedics | Physicians, nurses, paramedics |
Total enrollment | 3004 | 9296 | 2043 |
Design | Superiority | Superiority | Non‐inferiority |
Method of randomization | Cluster randomization with cross‐over. Randomization units defined by EMS agencies | Cluster randomization without cross‐over. Randomized by individual paramedic | Randomization by patient—assignment determined by sealed opaque envelopes |
Primary outcome | 72‐hour survival | Hospital survival with favorable functional status | 28‐day survival with favorable neurologic status |
Patients not receiving any of study interventions | ∼12%a | ∼18%b | ∼0.7%c |
Primary finding | LT superior to ETI (72‐hour survival LT 18.3% versus ETI 15.4%, difference 2.9% (95% CI: 0.2–5.6), P = 0.04 | No difference between i‐gel and ETI (hospital survival with favorable functional outcome i‐gel 6.4% versus ETI 6.8%, OR 0.92% (95% CI: 0.77–1.09), P = 0.33) | Inconclusive (28‐day survival with favorable neurologic status BVM 4.3% versus ETI 4.2%, difference 0.11% (one‐sided 97.5% CI: −1.64 to 0), non‐inferiority P = 0.11) |
Important secondary findings |
Shorter EMS‐to‐airway time in LT than TI. Low airway insertion success rate in the ETI arm (51.6%). Allocation imbalance in select randomization clusters. |
Differential use of advanced airway management between groups. Superior initial ventilation success with i‐gel. No difference in regurgitation and aspiration between randomization groups. |
BVM associated with more difficult ventilation and higher aspiration. |
Patients who did not receive ETI or LT.
Patients who did not receive ETI or i‐gel.
Patients who did not receive ETI or BVM.