Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis

Authors

Leigh D. White, University of Queensland, Sunshine Coast University HospitalFollow
Thomas M. Melhuish, Royal Prince Alfred Hospital, University of New South Wales
Rhys S. Holyoak, University of WollongongFollow
Thomas Ryan, John Hunter Hospital, University of Notre Dame
Hannah Kempton, University of New South Wales, St Vincent's Hospital
Ruan Vlok, University of Notre Dame, University of New South Wales, Wagga Wagga Rural Referral Hospital

RIS ID

130739

Publication Details

White, L., Melhuish, T., Holyoak, R., Ryan, T., Kempton, H. & Vlok, R. (2018). Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis. American Journal of Emergency Medicine, 36 (12), 2298-2306.

Abstract

Objectives: To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during out-of-hospital cardiac arrest (OHCA).

Methods: A systematic search of five databases was performed by two independent reviewers until September 2018. 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. Odds Ratios (OR) with random effect modelling was used. 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-nine studies (n = 539,146) showed that overall, ETT use resulted in a heterogeneous, but significant increase in ROSC (OR = 1.44; 95%CI = 1.27 to 1.63; I²= 91%; p < 0.00001) and survival to admission (OR = 1.36; 95%CI = 1.12 to 1.66; I²= 91%; p = 0.002). There was no significant difference in survival to discharge or neurological outcome (p > 0.0125). On sensitivity analysis of RCTs, there was no significant difference in ROSC, survival to admission, survival to discharge or neurological outcome (p > 0.0125). 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: The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in survival or neurological outcome. In the presence of automated chest compressions, ETT intubation may result in survival benefits.