Cluster randomised trial of the clinical and cost effectiveness of the i‐gel supraglottic airway device versus tracheal intubation in the initial airway management of out of hospital cardiac arrest

Funder: NIHR/HTA (REC Number: 14/SC/1219)

Sponsor: South Western Ambulance Services NHS Foundation Trust

Cardiac arrest happens when the heart beat and breathing stop suddenly, and is one of the most extreme medical emergencies. The best initial treatment is cardiopulmonary resuscitation (CPR), a combination of rescue breathing and chest compressions. NHS ambulance staff currently provide rescue breathing by placing a breathing tube in the windpipe. This tube can cause significant complications as well as interruptions in chest compressions, which reduces delivery of blood and oxygen to the brain and heart. A newer method of rescue breathing involves the insertion of a supraglottic airway device (SAD); a tube that sits on top of the voice box. These are quicker to insert and cause less interruption to chest compressions. However, a SAD does not stay in place as securely as a breathing tube and, if a patient vomits, a SAD may not prevent stomach contents from entering their lungs. There is real uncertainty amongst paramedics and experts in the field about the best method to ensure a clear airway during the early stages of cardiac arrest.

The Airways-2 study recruited patients who had a cardiac arrest. Participants were allocated by chance to receive either the normal breathing tube or the newer SAD device, and followed up in hospital to determine their quality of life and the NHS resources they used during their hospital stay and subsequently.

AIRWAYS-2 has now closed to patient enrolment. Recruitment went well, and the study recruited over the target of 9,070 patients. Follow up was completed in February 2018, and the results paper was published in The Journal of the American Medical Association (JAMA) on the 28th August.

Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-Of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial 

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The AIRWAYS-2 trial team and sciencesplained worked together to create a scientific animation explaining the trial results.

AIRWAYS-2 is funded by the NIHR, and South Western Ambulance Service NHS Foundation Trust have overall responsibility for the conduct of the study.

NIHR Award Information


Contact information

Chief Investigator: Prof. Jonathan Benger