AIRWAYS-3 Trial: Advanced Airway Management in In-Hospital Cardiac Arrest
AIRWAYS-3 is a multi-centre, open-label, randomized trial evaluating the clinical and cost effectiveness of a supraglottic airway (SGA) versus tracheal intubation during in-hospital cardiac arrest (IHCA). The trial aims to determine the functional status and health-related quality of life outcomes of adults who have suffered IHCA. The study will enroll 4,190 participants across UK hospitals, with a focus on survival with a favorable functional outcome. Initial pilot studies have been successful, and recruitment is ongoing for the main trial.
- AIRWAYS-3 Trial
- Advanced Airway Management
- In-Hospital Cardiac Arrest
- Clinical Effectiveness
- Cost-Effectiveness
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An RCT of advanced airway management for patients who have suffered an in-hospital cardiac arrest (IHCA) AIRWAYS-3 is a multi-centre, open-label, randomised trial and economic evaluation to determine the clinical and cost effectiveness of a supraglottic airway (SGA) versus tracheal intubation during in-hospital cardiac arrest.
AIRWAYS-3 CARDIAC ARREST CPD WEBINAR Professor Jonathan Benger AIRWAYS-3 Updates Dr Jasmeet Soar Perioperative cardiac arrest Professor Jerry Nolan Pan-CT after cardiac arrest
Randomised trial of the clinical and cost effectiveness of a supraglottic airway device versus tracheal intubation during in-hospital cardiac arrest (AIRWAYS-3) Chief Investigator: Prof. Jonathan Benger CBE Sponsor:University Hospitals Bristol and Weston Coordinating Centre: Warwick Clinical Trials Unit Funder: National Institute for Health and Care Research Contact: airways3@warwick.ac.uk Website: www.warwick.ac.uk/airways3
Design A multi-centre, open-label, pragmatic, individually randomised, parallel group, superiority trial and economic evaluation to determine the clinical and cost effectiveness of a supraglottic airway (SGA) versus tracheal intubation (TI) during in-hospital cardiac arrest (IHCA). The trial will include an internal pilot to confirm feasibility Population Adult hospital inpatients receiving resuscitation following IHCA that requires a 2222 call and advanced airway management Intervention Supraglottic airway device (SGA) Comparator Tracheal intubation Outcome Functional status at hospital discharge (or 30 days post-randomisation whichever is shorter) as measured by the modified Rankin Scale (mRS) Setting UK hospitals; international recruitment under consideration Sample size 4,190 participants (2,095 per group) 1st Dec 2022 (30 pilot sites) then January 2024 (80 trial sites) for 18 months Recruitment Period
Aim of the AIRWAYS-3 trial 1. Conduct an internal pilot study to confirm the feasibility of the large-scale multi-centre trial. 2. Determine the clinical effectiveness of SGA versus tracheal intubation, for adults with in-hospital cardiac arrest, in terms of survival with a favourable functional outcome and health-related quality of life. 3. Estimate, in an integrated economic evaluation, the cost- effectiveness of SGA compared with tracheal intubation.
Review of pilot phase Meeting with funder 06/02/2024 confirmed successful completion of pilot phase 38 sites open across 30 trusts and 13 LCRNs in England and Wales 350 participants randomised Best month of recruitment January 2024 with 65 participants 1294 staff completed training 54% of all eligible participants recruited
43 Open sites: Bristol Royal (UHBW) Royal Preston RUH Bath East Kent (QETQM) Hammersmith Pinderfields North Bristol - Southmead Sherwood Forest Hospitals Bradford Royal Infirmary Gloucestershire Princess Alexandra Great Western Rotherham Weston General (UHBW) Liverpool University Hospitals NHS FT Worcester Royal Alexandra Hospital Maidstone Hospital Tunbridge wells Hospital St George's University Hospitals NHS FT Worthing Hospital (UHS) Royal Devon and Exeter Wye Valley Trust - Hereford Whiston Hospital Princess Royal Hospital Royal Sussex County UHD - Poole Hospital UHD - Bournemouth Hospital The Queen Elizabeth Hospital Kings Lynn Heartlands Hospital St Richards William Harvey (UKUHFT) Good Hope Hospital Ealing Hospital Northwick Park Hospital Ysbyty Gwynedd New Cross Hospital Wrexham Maelor Hospital Southport and Formby District General Hospital West Middlesex University Hospital York and Scarborough University Hospital Wales University Hospital Llandough Recruitment and site update 2500 2000 1500 1000 500 343389444 233 278 123154199 97 74 59 37 23 12 9 0 1 Jul-23 Jul-24 Jun-23 Jun-24 Apr-23 May-23 Apr-24 May-24 Dec-22 Mar-23 Nov-23 Dec-23 Mar-24 Feb-23 Aug-23 Sep-23 Feb-24 Aug-24 Jan-23 Jan-24 Oct-23 Targets Recruitment Projections Current recruitment total: 473
Eligibility Criteria change in January Adult (known or believed to be age >=18 years). Patients who have a cardiac arrest outside hospital and who are transported to the hospital in ongoing cardiac arrest In-hospital cardiac arrest, attended by the hospital cardiac arrest team in response to a cardiac arrest call (2222 or equivalent), and when a clinician permitted to undertake both tracheal intubation and supraglottic airway placement (so that either intervention can be delivered) is present. People who are not a hospital inpatient (e.g. visitor, relative, staff or outpatient). Patients who are already tracheally intubated at the time of eligibility assessment. Patients known to be pregnant. Undergoing resuscitation and requiring advanced airway management in the opinion of the trained clinician responsible for randomisation. Patients with a functioning tracheostomy
Training Training for AIRWAYS-3 is hosted on our website, and takes 10 minutes to complete: Airways3 training (warwick.ac.uk) You must complete the form at the end of the training slides (Airways3 Training Checklist (warwick.ac.uk)), or email airways3@warwick.ac.uk to confirm your training Once you have completed the training (and are at an open site) we will send you a PWA login code and you ll be ready to randomise AIRWAYS-3 RAND APP (warwick.ac.uk)
