Improved functional survival after OHCA is associated with increased advanced airway management at the prefecture level: The All-Japan Utstein Registry

Background: Out-of-hospital cardiac arrest (OHCA) has high incidence and mortality. The survival benefit of advanced airway management (AAM) for OHCA remains controversial. In Japan, AAM are performed for OHCA by EMS, however the relationship between resuscitation outcomes and AAM at the prefecture level has not been evaluated. The purpose of this study was to describe the association between AAM and neurologically favorable survival (CPC ≦ 2) at prefecture level. Methods This was a retrospective, population-based study of adult OHCA patients ( ≧ 18) from 2014 to 2017 in Japan. We categorized OHCA into four quartiles based on AAM by prefecture and assessed the CPC ≦ 2 for each quartile. Multivariable logistic regression was used to assess impact of AAM on survival. Results Among 493,577 OHCA cases, 403,707 matched our inclusion criteria. They were classified into quartiles based on AAM by prefecture (G1: Lowest AAM group, G4: Highest AAM group). The number of CPC ≦ 2 survivors increased from G1 to G4. In the adjusted multivariable regression, higher AAM use was associated with CPC ≦ 2. Conclusions High prefecture AAM use was associated with neurologically favorable survival (CPC ≦ 2) in OHCA. Further studies are needed to better understand these finding.