Emory and Grady to study best airway management during emergencies; clinical trial enrollment begins in early 2020

Emory University Department of Emergency Medicine and Grady Memorial Hospital are joining together to take part in a U.S. Department of Defense-funded clinical trial to compare different ways to help people with traumatic injuries breathe. The Emory/Grady site is one of nine academic medical centers taking part in the nationwide study.

The Prehospital Airway Control Trial (PACT) is a four-year, $8.8 million study to test different interventions for securing a person’s airway at the scene of a trauma to assess effectiveness at improving survival rates. Prehospital or EMS (emergency medical services) providers typically use one of two methods to help people breathe – an endotracheal tube, which is placed in a person’s windpipe, or a supraglottic airway device, which is placed over a person’s windpipe. Both tubes are inserted through the mouth and into the airway, then are connected to a ventilation device – either a machine or a bag that can be pumped with the hand — to deliver oxygen to the lungs.

“Both approaches are currently used and while both methods have their individual benefits and risks, this study will hopefully help us determine best practice for the ideal device for airway control in trauma patients,” says Lekshmi Kumar, MD, MPH, associate professor in the Department of Emergency Medicine at Emory and principal investigator of the PACT trial at Emory and Grady. “Observational studies suggest that airway obstruction is a major cause of preventable death among trauma patients. Therefore, airway evaluation and management remain the critical first steps in the treatment of any severely injured patient.”

Patients who are brought to Grady Memorial Hospital by ambulance will have the opportunity to be a part of the trial. Given it requires performing a potentially life-saving procedure in people who are too injured to consent, patients who meet the criteria will be automatically enrolled and the traditional informed consent process will take place following management of the trauma.

To be enrolled in the clinical trial, patients must be in a coma and have an inability to oxygenate or ventilate adequately.

“There has been debate over the years about which breathing mechanism is better to use during emergencies,” says Kumar. “While the supraglottic device is believed to be easier to place, the endotracheal tube may be associated with less risk of the patient aspirating fluid into their lungs and other device-related complications. The goal of the trial is to find the best breathing approach for trauma victims at the scene of an event.”

Over the next four years, the study will enroll more than 2,000 participants ages 15 and older who are taken to one of the nine adult trauma center study sites for care. Enrollment for the Emory/Grady site is expected to begin in early 2020. For more  information on the study, visit litesnetwork.org.

This research is funded by Department of Defense contract W81XWH18F0426.