Early endotracheal intubation improves neurological outcome following witnessed out‐of‐hospital cardiac arrest in Japan: a population‐based observational study

Aim It is unclear whether endotracheal intubation in the prehospital setting improves outcomes following out‐of‐hospital cardiac arrest. The purpose of this study was to evaluate the association between endotracheal intubation time (time from patient contact to endotracheal intubation) and favorable neurological outcomes on out‐of‐hospital cardiac arrest. Methods We extracted patients who underwent endotracheal intubation on the scene from a nationwide out‐of‐hospital cardiac arrest database registered between 2014 and 2017 in Japan. We included 14,969 witnessed and intubated adult out‐of‐hospital cardiac arrest cases. Patients were divided into Shockable ( n  = 1,102) and Non‐shockable ( n  = 13,867) cohorts. We first drew the logistic curve due to predicting the association between endotracheal intubation time and favorable neurological outcome defined as Cerebral Performance Category (CPC) 1 or 2. Secondary, multivariable logistic regressions were used to estimate the association between the endotracheal intubation time (1‐min unit increase), CPC 1 or 2. Results The logistic curve for CPC 1 or 2 showed similar shapes and indicated a decreasing outcome over time. From the results of multivariable logistic regression, in the Shockable cohort, endotracheal intubation time delay was correlated with decreasing favorable outcomes: CPC 1 or 2 (adjusted odds ratio, 0.89; 95% confidence interval, 0.82–0.87). Results were the same for the Non‐shockable cohort: CPC 1 or 2 (adjusted odds ratio, 0.94; 95% confidence interval, 0.89–0.99). Conclusion Early endotracheal intubation was correlated with favorable neurological outcome. Training for intubation skills and improving protocols are needed for carrying out early endotracheal intubation.