{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T03:38:04Z","timestamp":1768275484714,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Heart and Lung Foundation","award":["20160637"],"award-info":[{"award-number":["20160637"]}]},{"name":"Laerdal Foundation","award":["20160637"],"award-info":[{"award-number":["20160637"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Trans-nasal evaporative cooling is an effective method to induce intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest (OHCA). The use of supraglottic airway devices (SGA) instead of endotracheal intubation may enable shorter time intervals to induce cooling. We aimed to study the outcomes in OHCA patients receiving endotracheal intubation (ETI) or a SGA during intra-arrest trans-nasal evaporative cooling. Methods: This is a pre-specified sub-study of the PRINCESS trial (NCT01400373) that included witnessed OHCA patients randomized during resuscitation to trans-nasal intra-arrest cooling vs. standard care followed by temperature control at 33 \u00b0C for 24 h. For this study, patients randomized to intra-arrest cooling were stratified according to the use of ETI vs. SGA prior to the induction of cooling. SGA was placed by paramedics in the first-tier ambulance or by physicians or anesthetic nurses in the second tier while ETI was performed only after the arrival of the second tier. Propensity score matching was used to adjust for differences at the baseline between the two groups. The primary outcome was survival with good neurological outcome, defined as cerebral performance category (CPC) 1\u20132 at 90 days. Secondary outcomes included time to place airway, overall survival at 90 days, survival with complete neurologic recovery (CPC 1) at 90 days and sustained return of spontaneous circulation (ROSC). Results: Of the 343 patients randomized to the intervention arm (median age 64 years, 24% were women), 328 received intra-arrest cooling and had data on the airway method (n = 259 with ETI vs. n = 69 with SGA). Median time from the arrival of the first-tier ambulance to successful airway management was 8 min for ETI performed by second tier and 4 min for SGA performed by the first or second tier (p = 0.001). No significant differences in the probability of good neurological outcome (OR 1.43, 95% CI 0.64\u20133.01), overall survival (OR 1.26, 95% CI 0.57\u20132.55), full neurological recovery (OR 1.17, 95% CI 0.52\u20132.73) or sustained ROSC (OR 0.88, 95% CI 0.50\u20131.52) were observed between ETI and SGA. Conclusions: Among the OHCA patients treated with trans-nasal evaporative intra-arrest cooling, the use of SGA was associated with a significantly shorter time to airway management and with similar outcomes compared to ETI.<\/jats:p>","DOI":"10.3390\/jcm11216370","type":"journal-article","created":{"date-parts":[[2022,10,30]],"date-time":"2022-10-30T07:26:50Z","timestamp":1667114810000},"page":"6370","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Strategies of Advanced Airway Management in Out-of-Hospital Cardiac Arrest during Intra-Arrest Hypothermia: Insights from the PRINCESS Trial"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6034-8506","authenticated-orcid":false,"given":"Jonathan","family":"Tjerkaski","sequence":"first","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hermansson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emelie","family":"Dillenbeck","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio Silvio","family":"Taccone","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB), 1070 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-384X","authenticated-orcid":false,"given":"Anatolij","family":"Truhlar","sequence":"additional","affiliation":[{"name":"Emergency Medical Services of the Hradec Kralove Region, 500 05 Hradec Kralove, Czech Republic"},{"name":"Department of Anaesthesiology and Intensive Care Medicine, Charles University in Prague, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sune","family":"Forsberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Hollenberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattias","family":"Ringh","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leif","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karolinska Institute, 17176 Solna, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per","family":"Nordberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute, 11883 Stockholm, Sweden"},{"name":"Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.resuscitation.2005.03.021","article-title":"Incidence of EMS-treated out-of-hospital cardiac arrest in Europe","volume":"67","author":"Atwood","year":"2005","journal-title":"Resuscitation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.resuscitation.2019.12.042","article-title":"Survival after out-of-hospital cardiac arrest in Europe\u2014Results of the EuReCa TWO 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Methods"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6370\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:04:46Z","timestamp":1760144686000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6370"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,28]]},"references-count":26,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jcm11216370"],"URL":"https:\/\/doi.org\/10.3390\/jcm11216370","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,28]]}}}