{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:50:11Z","timestamp":1793145011763,"version":"4.5.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250895-4\"><jats:title>Importance<\/jats:title><jats:p>While variable advanced airway devices are used in out-of-hospital cardiac arrest (OHCA) resuscitation, potential differences in ventilation metrics are not well known.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250895-5\"><jats:title>Objective<\/jats:title><jats:p>To characterize differences in end-tidal carbon dioxide (EtCO<jats:sub>2<\/jats:sub>) capnography trajectories between laryngeal tube (LT) and endotracheal intubation (ETI) during OHCA.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250895-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This secondary analysis of EtCO<jats:sub>2<\/jats:sub> capnography waveforms from the Pragmatic Airway Resuscitation Trial (PART), a multicenter cluster-crossover randomized clinical trial, was performed November 1, 2023, through July 8, 2025. Participants in this analysis were adults (aged \u226518 years) with nontraumatic OHCA from 27 emergency medical services (EMS) agencies, which were placed into 13 clusters. Participants were assigned to LT or ETI airway management. All cases with 50% or greater interpretable EtCO<jats:sub>2<\/jats:sub> signal were included.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250895-7\"><jats:title>Interventions<\/jats:title><jats:p>LT vs ETI airway management.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250895-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Mean maximal EtCO<jats:sub>2<\/jats:sub> values within 1-minute epochs and trends over resuscitation after LT or ETI. Associations with OHCA outcomes were also evaluated, including sustained return of spontaneous circulation (ROSC) and 72-hour survival. Using the Mann-Whitney test, EtCO<jats:sub>2<\/jats:sub> of LT and ETI cases were compared at 20-, 10-, and 1-minute resuscitation. EtCO<jats:sub>2<\/jats:sub> trends over time were evaluated using Cochran-Armitage test of trend. Covariates in multivariable logistic regression models for outcomes were adjusted, including interaction between advanced airway device and EtCO<jats:sub>2<\/jats:sub> trends.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250895-9\"><jats:title>Results<\/jats:title><jats:p>Of the 3004 cases in PART, 1113 (818 in LT and 295 in ETI groups) had available EtCO<jats:sub>2<\/jats:sub> data and were included in the secondary analysis. Patients were mostly male (694 [62.4%]), had a median (IQR) age of 64 (52-75) years, and had a nonshockable (941 [84.6%]), nonpublic (999 [89.8%]) OHCA. ROSC occurred in 144 patients (17.6%) receiving LT and 54 (18.3%) receiving ETI. EtCO<jats:sub>2<\/jats:sub> values did not differ between LT and ETI groups (20-minute resuscitation: 33.9 vs 29.4 mm Hg, <jats:italic>P<\/jats:italic>\u2009=\u2009.07; 10-minute resuscitation: 30.9 vs 28.5 mm Hg, <jats:italic>P<\/jats:italic>\u2009=\u2009.89; 1-minute resuscitation: 32.2 vs 28.3 mm Hg, <jats:italic>P<\/jats:italic>\u2009=\u2009.28). In ROSC compared with non-ROSC cases, patients in LT (27.9 to 52.3 mm Hg vs 32.6 to 23.5 mm Hg; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and ETI (38.2 to 46.7 mm Hg vs 27.7 to 20.0 mm Hg; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) groups exhibited increasing EtCO<jats:sub>2<\/jats:sub> during resuscitation. EtCO<jats:sub>2<\/jats:sub> trend and advanced airway interaction was associated with ROSC (odds ratio [OR], 1.75; 95% CI, 1.25-2.45) but not survival (OR, 1.21; 95% CI, 0.90-1.61). Therefore, we performed an advanced airway stratified analysis for ROSC (ETI: OR, 2.34 [95% CI, 1.67-3.26]; LT: OR, 1.33 [95% CI, 1.20-1.47]).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250895-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this secondary analysis of PART, EtCO<jats:sub>2<\/jats:sub> values did not differ between LT and ETI. However, due to significant interaction between advanced airway device and EtCO<jats:sub>2<\/jats:sub> trends, individual interpretation of these parameters may not be accurate.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.31511","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T15:00:31Z","timestamp":1757948431000},"page":"e2531511","source":"Crossref","is-referenced-by-count":2,"title":["Advanced Airway Devices and End-Tidal Capnography Trends in Cardiac Arrest"],"prefix":"10.1001","volume":"8","author":[{"given":"Michelle M. J.","family":"Nassal","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, The Ohio State University, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andoni","family":"Elola","sequence":"additional","affiliation":[{"name":"Department of Electronic Technology, BioRes Group, University of the Basque Country, Universidad del Pa\u00eds Vasco\/Euskal Herriko Unibertsitatea (UPV\/EHU), Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabete","family":"Aramendi","sequence":"additional","affiliation":[{"name":"Department of Communication Engineering, BioRes Group, University of the Basque Country, UPV\/EHU, Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Gage","sequence":"additional","affiliation":[{"name":"National Registry of Emergency Medical Technicians, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Powell","sequence":"additional","affiliation":[{"name":"ImageTrend, LLC, Eagan, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xabier","family":"Jaureguibeitia","sequence":"additional","affiliation":[{"name":"Department of Communication Engineering, BioRes Group, University of the Basque Country, UPV\/EHU, Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahamed H.","family":"Idris","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamud R.","family":"Daya","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, Emergency Medicine, The Ohio State University, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom P.","family":"Aufderheide","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jestin","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon W.","family":"Stephens","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Nichol","sequence":"additional","affiliation":[{"name":"Harborview Center for Prehospital Emergency Care, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Schmicker","sequence":"additional","affiliation":[{"name":"University of Washington Clinical Trial Center, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish R.","family":"Panchal","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Ohio State University, Columbus"},{"name":"National Registry of Emergency Medical Technicians, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry E.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Ohio State University, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"issue":"1","key":"zoi250895r1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.hlc.2018.08.026","article-title":"Epidemiology of sudden cardiac death: global and regional perspectives.","volume":"28","author":"Wong","year":"2019","journal-title":"Heart Lung Circ"},{"issue":"16_suppl_2","key":"zoi250895r2","doi-asserted-by":"publisher","first-page":"S366","DOI":"10.1161\/CIR.0000000000000916","article-title":"Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.","volume":"142","author":"Panchal","year":"2020","journal-title":"Circulation"},{"issue":"8","key":"zoi250895r3","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1001\/jama.2018.7044","article-title":"Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial.","volume":"320","author":"Wang","year":"2018","journal-title":"JAMA"},{"issue":"8","key":"zoi250895r4","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1001\/jama.2018.11597","article-title":"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.","volume":"320","author":"Benger","year":"2018","journal-title":"JAMA"},{"issue":"5","key":"zoi250895r5","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.resuscitation.2014.02.007","article-title":"Airway management and out-of-hospital cardiac arrest outcome in the CARES Registry.","volume":"85","author":"McMullan","year":"2014","journal-title":"Resuscitation"},{"issue":"9","key":"zoi250895r6","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010105.pub2","article-title":"Supraglottic airway devices versus tracheal intubation for airway management during general anaesthesia in obese patients.","volume":"2013","author":"Nicholson","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"zoi250895r7","doi-asserted-by":"publisher","first-page":"270","DOI":"10.5152\/TJAR.2017.44711","article-title":"Clinical comparison of I-gel supraglottic airway device and cuffed endotracheal tube for pressure-controlled ventilation during routine surgical procedures.","volume":"45","author":"Dhanda","year":"2017","journal-title":"Turk J Anaesthesiol Reanim"},{"issue":"3","key":"zoi250895r8","doi-asserted-by":"publisher","first-page":"521","DOI":"10.4103\/0259-1162.180780","article-title":"Comparison of I-gel and Laryngeal Mask Airway Classic in terms of ease of insertion and hemodynamic response: a randomized observational study.","volume":"10","author":"Pratheeba","year":"2016","journal-title":"Anesth Essays Res"},{"issue":"7","key":"zoi250895r9","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.19274","article-title":"Temporal trends in end-tidal capnography and outcomes in out-of-hospital cardiac arrest: a secondary analysis of a randomized clinical trial.","volume":"7","author":"Nassal","year":"2024","journal-title":"JAMA Netw Open"},{"key":"zoi250895r10","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.ajem.2023.11.030","article-title":"Utility of end-tidal carbon dioxide to guide resuscitation termination in prolonged out-of-hospital cardiac arrest.","volume":"77","author":"Hambelton","year":"2024","journal-title":"Am J Emerg Med"},{"key":"zoi250895r11","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/1745-6215-11-32","article-title":"CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.","volume":"11","author":"Schulz","year":"2010","journal-title":"Trials"},{"issue":"5","key":"zoi250895r12","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1177\/2047487312451815","article-title":"Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black US populations fare worse.","volume":"21","author":"Shah","year":"2014","journal-title":"Eur J Prev Cardiol"},{"key":"zoi250895r13","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.resuscitation.2016.08.033","article-title":"Feasibility of the capnogram to monitor ventilation rate during cardiopulmonary resuscitation.","volume":"110","author":"Aramendi","year":"2017","journal-title":"Resuscitation"},{"key":"zoi250895r14","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.resuscitation.2021.09.005","article-title":"Methodology and framework for the analysis of cardiopulmonary resuscitation quality in large and heterogeneous cardiac arrest datasets.","volume":"168","author":"Jaureguibeitia","year":"2021","journal-title":"Resuscitation"},{"key":"zoi250895r15","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.resuscitation.2019.03.048","article-title":"Capnography: a support tool for the detection of return of spontaneous circulation in out-of-hospital cardiac arrest.","volume":"142","author":"Elola","year":"2019","journal-title":"Resuscitation"},{"key":"zoi250895r16","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2022.109679","article-title":"Methods for calculating ventilation rates during resuscitation from out-of-hospital cardiac arrest.","volume":"184","author":"Wang","year":"2023","journal-title":"Resuscitation"},{"key":"zoi250895r17","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.resuscitation.2022.05.008","article-title":"Airway strategy and ventilation rates in the pragmatic airway resuscitation trial.","volume":"176","author":"Wang","year":"2022","journal-title":"Resuscitation"},{"key":"zoi250895r18","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.resuscitation.2020.11.030","article-title":"Airway insertion first pass success and patient outcomes in adult out-of-hospital cardiac arrest: the Pragmatic Airway Resuscitation Trial.","volume":"158","author":"Lesnick","year":"2021","journal-title":"Resuscitation"},{"issue":"2","key":"zoi250895r19","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.annemergmed.2021.07.114","article-title":"Association of advanced airway insertion timing and outcomes after out-of-hospital cardiac arrest.","volume":"79","author":"Okubo","year":"2022","journal-title":"Ann Emerg Med"},{"key":"zoi250895r20","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1080\/10903127.2020.1856985","article-title":"Methods and Implementation of the 2019 EMS Practice Analysis.","author":"Panchal","year":"2022","journal-title":"Prehosp Emerg Care"},{"key":"zoi250895r21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.resuscitation.2017.12.003","article-title":"The use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: a systematic review.","volume":"123","author":"Paiva","year":"2018","journal-title":"Resuscitation"},{"issue":"5","key":"zoi250895r22","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.annemergmed.2023.03.001","article-title":"Out-of-hospital arterial to end-tidal carbon dioxide gradient in patients with return of spontaneous circulation after out-of-hospital cardiac arrest: a retrospective study.","volume":"82","author":"Eichlseder","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"3","key":"zoi250895r23","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/S0196-0644(94)70080-X","article-title":"End-tidal carbon dioxide during extremely low cardiac output.","volume":"23","author":"Idris","year":"1994","journal-title":"Ann Emerg Med"},{"key":"zoi250895r24","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.resuscitation.2015.01.026","article-title":"Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest.","volume":"89","author":"Sheak","year":"2015","journal-title":"Resuscitation"},{"key":"zoi250895r25","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/j.resuscitation.2022.07.009","article-title":"Contribution of chest compressions to end-tidal carbon dioxide levels generated during out-of-hospital cardiopulmonary resuscitation.","volume":"179","author":"Guti\u00e9rrez","year":"2022","journal-title":"Resuscitation"},{"issue":"3","key":"zoi250895r26","doi-asserted-by":"publisher","first-page":"369","DOI":"10.3109\/10903127.2015.1115929","article-title":"Association between prehospital CPR quality and end-tidal carbon dioxide levels in out-of-hospital cardiac arrest.","volume":"20","author":"Murphy","year":"2016","journal-title":"Prehosp Emerg Care"},{"key":"zoi250895r27","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.resuscitation.2020.06.007","article-title":"The impact of ventilation rate on end-tidal carbon dioxide level during manual cardiopulmonary resuscitation.","volume":"156","author":"Ruiz de Gauna","year":"2020","journal-title":"Resuscitation"},{"key":"zoi250895r28","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.ajem.2023.11.027","article-title":"End-tidal carbon dioxide after sodium bicarbonate infusion during mechanical ventilation or ongoing cardiopulmonary resuscitation.","volume":"76","author":"Roh","year":"2024","journal-title":"Am J Emerg Med"},{"issue":"3","key":"zoi250895r29","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/0735-6757(94)90136-8","article-title":"Effect of epinephrine on end-tidal carbon dioxide pressure during prehospital cardiopulmonary resuscitation.","volume":"12","author":"Cantineau","year":"1994","journal-title":"Am J Emerg Med"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2838880\/nassal_2025_oi_250895_1757342643.98299.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T15:00:32Z","timestamp":1757948432000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2838880"}},"subtitle":["A Secondary Analysis of a Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":29,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.31511","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,15]]}}}