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Advanced airway management in out of hospital cardiac arrest: A Systematic Review and Meta-Analysis

Ruan Vlok

Importance

Currently there is no clear evidence as to which advanced airway device should be used during an out-of-hospital cardiac arrest (OHCA).To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during OHCA.

Data Sources

A systematic search of five databases was performed by two independent reviewers until June 2018.

Study Selection

Included studies reported on (1) OHCA or cardiopulmonary resuscitation, and (2) endotracheal intubation versus supraglottic airway device intubation. Exclusion criteria (1) stimulation studies, (2) selectively included/excluded  patients, (3) in-hospital cardiac arrest.

Main Outcomes and Measures

Primary outcomes (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, (4) discharge with a neurologically intact state.

Results

Twenty-six studies (n=526,642) showed that overall, ETT use resulted in a heterogenous, but significant increase in ROSC (OR=1.52; 95% CI=1.35 to 1.71; I2=88%;  p<0.00001) and survival to admission (OR=1.45; 95%CI=1.17 to 1.78; I2=90%; p=0.0006). There was no significant difference in survival to discharge or neurological outcome(p=0.10).  On sensitivity analysis of RCTs, without heterogeneity, there was no significant difference in ROSC (I2=0%; p=0.59) or survival to admission (I2=0%; p=0.99).  On analysis of automated chest compression, without heterogeneity, ETT provided a significant increase in ROSC (OR=1.55; 95%CI=1.20 to 2.00; I2=0%; p=0.0009) and survival to admission (OR=2.16; 95%CI=1.54 to 3.02; I2=0%;  p<0.00001).

Conclusions and Relevance

The overall heterogenous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in ROSC or survival to admission.  In the presence of automated chest compressions, ETT intubation may result in survival benefits.

November, 2020
10.37912/WaggaJOM.0201.17

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