An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients receiving mechanical CPR with endotracheal or supraglottic airways

Becker, Torben K.; Berning, Aric W.; Prabhu, Arjun; Callaway, Clifton W.; Guyette, Francis X.; Martin‐Gill, Christian

doi:10.1016/j.resuscitation.2017.11.054

Cited by 11 publications

(7 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…35,36 and 37,38 and 14,17 These studies included three RCTs, 14,17,[37][38][39] one controlled clinical trial (CCT) which was included with the RCTs in the meta analyses, 35,36 three prospective cohorts, 18,21,22 and 15 retrospective cohorts. [23][24][25][26][28][29][30][31][32][33][40][41][42][43] Seven of these studies were rated low ROB, 23,25,26,31,[37][38][39]42 six moderate, 24,29,32,33,41 and three high. 30,40,43 Three were rated low ROB for survival and moderate for ROSC or neurological function outcomes.…”

Section: Summary Of Resultsmentioning

confidence: 99%

“…31 Most of the studies (15 of 22) included multiple emergency medical services (EMS) agencies or ambulance services. 14,17,18,21,23,24,26,28,31,32,[35][36][37][38][39][40]43 However, less than half (10 studies) were conducted in the United States, or the United States and Canada; 14,17,18,[24][25][26]35,36,[40][41][42][43] nine were conducted in Asia (Japan, South Korea, Taiwan, Thailand); 22,23,[28][29][30][31][32][33]43 two in Europe; 21,37,38 and one in Australia. 39…”

Section: Summary Of Resultsmentioning

confidence: 99%

“…Eighteen studies contained data on survival for Key Question 2 comparing BVM and ETI, including 4 RCTs 14,17,[35][36][37]39 and 14 observational studies. 18,[21][22][23][24][25][26]28,30,32,[40][41][42] Across age groups and emergency types, the findings showed no difference in survival inhospital or at 1-month post incident when comparing BVM to ETI for prehospital airway management (Table 10; Appendix Figure H-4). For adult/mixed age cardiac arrest patients, we rated the SOE as moderate for this finding of no difference because the pooled estimates are based on several studies that included a large number of patients.…”

Section: Survivalmentioning

confidence: 99%

See 2 more Smart Citations

Prehospital Airway Management: A Systematic Review

Carney¹,

Cheney²,

Totten³

et al. 2021

View full text Add to dashboard Cite

Objective. To assess the comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) by emergency medical services in the prehospital setting, and how the benefits and harms differ based on patient characteristics, techniques, and devices. Data sources. We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020 and reference lists, and posted a Federal Register notice request for data. Review methods. Review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center Program methods guidance. Using pre-established criteria, studies were selected and dual reviewed, data were abstracted, and studies were evaluated for risk of bias. Meta-analyses using profile-likelihood random effects models were conducted when data were available from studies reporting on similar outcomes, with analyses stratified by study design, emergency type, and age. We qualitatively synthesized results when meta-analysis was not indicated. Strength of evidence (SOE) was assessed for primary outcomes (survival, neurological function, return of spontaneous circulation [ROSC], and successful advanced airway insertion [for SGA and ETI only]). Results. We included 99 studies (22 randomized controlled trials and 77 observational studies) involving 630,397 patients. Overall, we found few differences in primary outcomes when airway management approaches were compared. • For survival, there was moderate SOE for findings of no difference for BVM versus ETI in adult and mixed-age cardiac arrest patients. There was low SOE for no difference in these patients for BVM versus SGA and SGA versus ETI. There was low SOE for all three comparisons in pediatric cardiac arrest patients, and low SOE in adult trauma patients when BVM was compared with ETI. • For neurological function, there was moderate SOE for no difference for BVM compared with ETI in adults with cardiac arrest. There was low SOE for no difference in pediatric cardiac arrest for BVM versus ETI and SGA versus ETI. In adults with cardiac arrest, neurological function was better for BVM and ETI compared with SGA (both low SOE). • ROSC was applicable only in cardiac arrest. For adults, there was low SOE that ROSC was more frequent with SGA compared with ETI, and no difference for BVM versus SGA or BVM versus ETI. In pediatric patients there was low SOE of no difference for BVM versus ETI and SGA versus ETI. • For successful advanced airway insertion, low SOE supported better first-pass success with SGA in adult and pediatric cardiac arrest patients and adult patients in studies that mixed emergency types. Low SOE also supported no difference for first-pass success in adult medical patients. For overall success, there was moderate SOE of no difference for adults with cardiac arrest, medical, and mixed emergency types. • While harms were not always measured or reported, moderate SOE supported all available findings. There were no differences in harms for BVM versus SGA or ETI. When SGA was compared with ETI, there were no differences for aspiration, oral/airway trauma, and regurgitation; SGA was better for multiple insertion attempts; and ETI was better for inadequate ventilation. Conclusions. The most common findings, across emergency types and age groups, were of no differences in primary outcomes when prehospital airway management approaches were compared. As most of the included studies were observational, these findings may reflect study design and methodological limitations. Due to the dynamic nature of the prehospital environment, the results are susceptible to indication and survival biases as well as confounding; however, the current evidence does not favor more invasive airway approaches. No conclusion was supported by high SOE for any comparison and patient group. This supports the need for high-quality randomized controlled trials designed to account for the variability and dynamic nature of prehospital airway management to advance and inform clinical practice as well as emergency medical services education and policy, and to improve patient-centered outcomes.

show abstract

Section: Summary Of Resultsmentioning

confidence: 99%

Section: Summary Of Resultsmentioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

See 1 more Smart Citation

Prehospital Airway Management: A Systematic Review

Carney¹,

Cheney²,

Totten³

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In addition, the literature contains controversial results regarding the need for ventilation during cardiopulmonary resuscitation. [60][61][62][63][64] Indeed, doubts persist regarding the need to intubate cardiac arrest patients at all [65][66][67][68] ; although a discussion of this issue is beyond the scope of our review, we can affirm that the benefits of protecting the airways and mechanical ventilation continue to be widely recognized and prioritized. 69,70 This review has only addressed the evidence regarding mechanical ventilation during mechanical CPR.…”

Section: Limitationsmentioning

confidence: 89%

Mechanical Ventilation Management During Mechanical Chest Compressions

et al. 2020

View full text Add to dashboard Cite

“…Airway management in cardiac arrest is essential for successful resuscitation [1]. Globally, i-gel has been used as a popular supraglottic airway device (SAD) for out-of-hospital cardiopulmonary resuscitation (CPR) [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Comparison of i-Gel as a Conduit for Intubation between under Fiberoptic Guidance and Blind Endotracheal Intubation during Cardiopulmonary Resuscitation: A Randomized Simulation Study

Choi

Kim

Jang

et al. 2019

Emergency Medicine International

View full text Add to dashboard Cite

Purpose This study aimed to compare intubation performances among i-gel blind intubation (IGI), i-gel bronchoscopic intubation (IBRI), and intubation using Macintosh laryngoscope (MCL) applying two kinds of endotracheal tube during chest compressions. We hypothesized that IGI using wire-reinforced silicone (WRS) tube could achieve endotracheal intubation most rapidly and successfully. Methods In 23 emergency physicians, a prospective randomized crossover manikin study was conducted to examine the three intubation techniques using two kinds of endotracheal tubes. The primary outcome was the intubation time. The secondary outcome was the cumulative success rate for each intubation technique. A significant difference was considered when identifying p < 0.05 between two devices or p < 0.017 in post hoc analysis of the comparison among three devices. Results The mean intubation time using IGI was shorter (p < 0.017) than that of using IBRI and MCL in both endotracheal tubes (17.6 vs. 29.3 vs. 20.2 in conventional polyvinyl chloride (PVC) tube; 14.6 vs. 27.4 vs. 19.9 in WRS tube; sec). There were no significant (p < 0.05) differences between PVC and WRS tubes for each intubation technique. The intubation time to reach 100% cumulative success rate was also shorter in IGI (p < 0.017) than that in IBRI and MCL in both PVC and WRS tubes. Conclusions IGI was an equally successful and faster technique compared with IBRI or MCL regardless of the use of PVC or WRS tube. IGI might be an appropriate technique for emergent intubation by experienced intubators during chest compressions.

show abstract

An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients receiving mechanical CPR with endotracheal or supraglottic airways

Cited by 11 publications

References 32 publications

Prehospital Airway Management: A Systematic Review

Prehospital Airway Management: A Systematic Review

Mechanical Ventilation Management During Mechanical Chest Compressions

Comparison of i-Gel as a Conduit for Intubation between under Fiberoptic Guidance and Blind Endotracheal Intubation during Cardiopulmonary Resuscitation: A Randomized Simulation Study

Contact Info

Product

Resources

About