Cost-effectiveness of the i-gel supraglottic airway device compared to tracheal intubation during out-of-hospital cardiac arrest: Findings from the AIRWAYS-2 randomised controlled trial

Stokes, Elizabeth A; Lazaroo, Michelle; Clout, Madeleine; Brett, Stephen; Black, Sarah; Kirby, Kim; Nolan, Jerry P.; Reeves, Barnaby C; Robinson, Maria; Rogers, Chris A; Scott, Lauren J; Smartt, Helena J.M.; South, Adrian; Taylor, Jodi; Thomas, Matthew; Voss, Sarah; Benger, Jonathan; Wordsworth, Sarah

doi:10.1016/j.resuscitation.2021.06.002

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…The results of studies aimed at comparing the effectiveness between ETI and SGA are contradictory; however, there are many variables influencing the worse prognosis of patients after OHCA during the COVID-19 pandemic, so the above-mentioned relationship seems unlikely. There is also no difference between SGA and ETI in terms of health-related quality of life or the cost-effectiveness of both procedures [50].…”

Section: Discussionmentioning

confidence: 94%

The impact of the COVID-19 pandemic on airway management with supraglottic airway devices among out-of-hospital cardiac arrests: a systematic review and meta-analysis

Dabkowski,

Bielski,

Pruc

et al. 2024

Medical Research Journal

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Introduction:The COVID-19 pandemic has led to increased cases of out-of-hospital cardiac arrest (OHCA), impacting emergency medical services and necessitating changes in resuscitation protocols to protect healthcare workers from virus transmission. Amidst these challenges, there's a shift in prehospital airway management techniques, with a renewed focus on endotracheal intubation over supraglottic airway devices for better protection against aerosol spread during cardiopulmonary resuscitation. This systematic review and meta-analysis aimed to examine the influence of the COVID-19 pandemic on the use of SGA as a method of securing the airway during out-of-hospital cardiac arrest.Material and methods: PubMed Central, Scopus, EMBASE, and the Cochrane Library databases were systematically searched. English-language literature was searched up to December 5th, 2023. This search was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Fixed and random effects models were used to undertake the meta-analysis when appropriate.The risk of bias was assessed through the Newcastle-Ottawa Scale.Results: Fifteen studies met the inclusion criteria for the meta-analysis. Pooled analysis showed that SGAs were chosen as the method of airway protection in 46.3% and 49.8% of cases, pre-vs. during the COVID-19 pandemic (OR = 0.76; 95%CI: 0.65 to 0.90; p = 0.001). In the case of endotracheal intubation, statistically significant differences were also observed in the frequency of use during OHCA in the pre-pandemic period vs. during the COVID-19 pandemic period (19.0% vs. 14.2%, respectively; OR = 1.66; 95%CI: 1.20 to 2.28; p = 0.002).Conclusions: The study's conclusions indicate a significant increase in the use of supraglottic airway devices during the COVID-19 pandemic for out-of-hospital cardiac arrests. Additionally, a decrease in the use of endotracheal intubation was observed. Effective airway management correlates with better outcomes after cardiac arrests, although the specific impact of these techniques during the pandemic remains unclear.

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Section: Discussionmentioning

confidence: 94%

The impact of the COVID-19 pandemic on airway management with supraglottic airway devices among out-of-hospital cardiac arrests: a systematic review and meta-analysis

Dabkowski,

Bielski,

Pruc

et al. 2024

Medical Research Journal

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“… 28 , 29 iGel supraglottic airway was assessed compared to tracheal intubation during arrest in two studies. 30 , 31 …”

Section: Resultsmentioning

confidence: 99%

“…28,29 iGel supraglottic was assessed compared to tracheal intubation arrest in two studies. 30,31 population The age of the simulated population ranged. Most of the included studies did not limit their population to a particular age, modeling for all patients experiencing non-traumatic cardiac OHCA (29 articles; 63%).…”

Section: Intervention and Comparatormentioning

confidence: 99%

A Systematic Review of Cost-Effectiveness of Treating Out of Hospital Cardiac Arrest: Implications for Resource-limited Health Systems

Werner,

Hirner,

Offorjebe

et al. 2024

Preprint

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Background Out-of-hospital cardiac arrest (OHCA) is a prevalent condition with high mortality and poor outcomes even in settings where extensive emergency care resources are available. Interventions to address OHCA have had limited success, with survival rates below 10% in national samples of high-income countries. In resource-limited settings, where scarcity requires careful priority setting, more data is needed to determine the optimal allocation of resources. Objective To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings. Methods The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints. Results 468 unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in TOR protocols, professional prehospital defibrillator use, and CPR training followed by distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment. Conclusion Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.

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“…Post-cardiac-arrest hospitalizations resulted in a high associated health care cost, with an increased length of stay, medical procedures, and systems of care [26]. The cost effectiveness of interventions should be discussed, but few studies were able to evaluate the economic impact of cardiac arrest in secondary analyses or outcome data [25,27,28].…”

Section: Discussionmentioning

confidence: 99%

Trend of Outcome Metrics in Recent Out-of-Hospital-Cardiac-Arrest Research: A Narrative Review of Clinical Trials

Htet,

Jafari,

Walker

et al. 2023

JCM

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Cardiopulmonary resuscitation (CPR) research traditionally focuses on survival. In 2018, the International Liaison Committee on Resuscitation (ILCOR) proposed more patient-centered outcomes. Our narrative review assessed clinical trials after 2018 to identify the trends of outcome metrics in the field OHCA research. We performed a search of the PubMed database from 1 January 2019 to 22 September 2023. Prospective clinical trials involving adult humans were eligible. Studies that did not report any patient-related outcomes or were not available in full-text or English language were excluded. The articles were assessed for demographic information and primary and secondary outcomes. We included 89 studies for analysis. For the primary outcome, 31 (35%) studies assessed neurocognitive functions, and 27 (30%) used survival. For secondary outcomes, neurocognitive function was present in 20 (22%) studies, and survival was present in 10 (11%) studies. Twenty-six (29%) studies used both survival and neurocognitive function. Since the publication of the COSCA guidelines in 2018, there has been an increased focus on neurologic outcomes. Although survival outcomes are used frequently, we observed a trend toward fewer studies with ROSC as a primary outcome. There were no quality-of-life assessments, suggesting a need for more studies with patient-centered outcomes that can inform the guidelines for cardiac-arrest management.

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Cost-effectiveness of the i-gel supraglottic airway device compared to tracheal intubation during out-of-hospital cardiac arrest: Findings from the AIRWAYS-2 randomised controlled trial

Cited by 6 publications

References 23 publications

The impact of the COVID-19 pandemic on airway management with supraglottic airway devices among out-of-hospital cardiac arrests: a systematic review and meta-analysis

The impact of the COVID-19 pandemic on airway management with supraglottic airway devices among out-of-hospital cardiac arrests: a systematic review and meta-analysis

A Systematic Review of Cost-Effectiveness of Treating Out of Hospital Cardiac Arrest: Implications for Resource-limited Health Systems

Trend of Outcome Metrics in Recent Out-of-Hospital-Cardiac-Arrest Research: A Narrative Review of Clinical Trials

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