Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in theinitial airway management of prehospital cardiac arrest (REVIVE-Airways): A feasibility study research protocol

Introduction: Effective cardiopulmonary resuscitationwith appropriate airway management improves outcomes following out-of-hospital cardiac arrest (OHCA). Historically, tracheal intubation has been accepted as the optimal form of OHCA airway management in the UK. The Joint Royal Colleges Ambulance Liaison Committee recently concluded that newer supraglottic airway devices (SADs) are safe and effective devices for hospital procedures and that their use in OHCA should be investigated. This study willaddress an identified gap in current knowledge byassessing whether it is feasible to use a clusterrandomised design to compare SADs with currentpractice, and also to each other, during OHCA.Methods and analysis: The primary objective of thisstudy is to assess the feasibility of a cluster randomisedtrial to compare the ventilation success of two newerSADs: the i-gel and the laryngeal mask airway supremeto usual practice during the initial airway management ofOHCA. The secondary objectives are to collect data onventilation success, further airway interventions required,loss of a previously established airway during transport,airway management on arrival at hospital (or terminationof the resuscitation attempt), initial resuscitation success,survival to intensive care admission, survival to hospital discharge and patient outcome at 3 months. Ambulance paramedics will be randomly allocated to one of the three methods of airway management. Adults in medical OHCA attended by a trial paramedic will be eligible for the study.Ethics and dissemination: Approval for the study hasbeen obtained from a National Health Service ResearchEthics Committee with authority to review proposals fortrials of a medical device in incapacitated adults. Theresults will be made publicly available on an open accesswebsite, and we will publish the findings in appropriatejournals and present them at national and internationalconferences relevant to the subject field.Trial registration: ISRCTN: 18528625