Increased First Pass Success with C-MAC Videolaryngoscopy in Prehospital Endotracheal Intubation—A Randomized Controlled Trial

Macke, Christian; Gralla, Felix; Winkelmann, Marcel; Clausen, Jan; Haertlé, Marco; Krettek, Christian; Omar, Mohamed

doi:10.3390/jcm9092719

Cited by 30 publications

(35 citation statements)

References 28 publications

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“…We identified and analyzed 17 studies (16 observational studies and one CCT; N=165,621) comparing RSI and ETI with no medication. 61,67,[70][71][72][73][74][75][76][77][78][79][80][81][82][83][84] Fourteen observational studies (N=144,206) provided data for pooled analysis of one or more outcomes. 61,67,70,[72][73][74][75][77][78][79][80][82][83][84] There were six studies (N=3,947) included for pooled analysis of survival to hospital discharge (Table 22, Appendix Figure H-12).…”

Section: Rapid Sequence Intubation Versus No Medicationmentioning

confidence: 99%

“…We included eight studies (N=33,887) for pooled analysis of first-pass success (Table 23, Appendix Figure H-13). 61,74,77,79,80,[82][83][84] Higher rates of first-pass success were observed with RSI in adults/mixed-age with mixed emergency types (SOE: Low). 61,74,80,82,84 When high ROB studies were excluded from analysis, there was no difference for RSI compared to no medication, based on two remaining studies (Appendix Figure I-9).…”

Section: Rapid Sequence Intubation Versus No Medicationmentioning

confidence: 99%

“…Five studies (4 observational and 1 CCT; N=31,778) were included for the comparison of RSI and ETI with sedation facilitation. 61,71,74,81,84 Three observational studies (N=5,842) provided data for pooled analysis of first-pass success (Table 27, Appendix Figure H-14). 61,74,84 For adult/mixed age patients with mixed emergency types, there were higher rates of first-pass success with RSI (SOE: Low).…”

Section: Rapid Sequence Intubation Versus Sedation-facilitatedmentioning

confidence: 99%

“…61,71,74,81,84 Three observational studies (N=5,842) provided data for pooled analysis of first-pass success (Table 27, Appendix Figure H-14). 61,74,84 For adult/mixed age patients with mixed emergency types, there were higher rates of first-pass success with RSI (SOE: Low). 61,74,84 SOE was insufficient for children with mixed emergency types, as there was only one observational study.…”

Section: Rapid Sequence Intubation Versus Sedation-facilitatedmentioning

confidence: 99%

“…61,74,84 For adult/mixed age patients with mixed emergency types, there were higher rates of first-pass success with RSI (SOE: Low). 61,74,84 SOE was insufficient for children with mixed emergency types, as there was only one observational study. 61 Additional outcomes and harms were qualitatively analyzed and are summarized in Tables 28 and 29, respectively.…”

Section: Rapid Sequence Intubation Versus Sedation-facilitatedmentioning

confidence: 99%

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Prehospital Airway Management: A Systematic Review

Carney¹,

Cheney²,

Totten³

et al. 2021

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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.

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Section: Rapid Sequence Intubation Versus No Medicationmentioning

confidence: 99%

Section: Rapid Sequence Intubation Versus No Medicationmentioning

confidence: 99%

Section: Rapid Sequence Intubation Versus Sedation-facilitatedmentioning

confidence: 99%

Section: Rapid Sequence Intubation Versus Sedation-facilitatedmentioning

confidence: 99%

Section: Rapid Sequence Intubation Versus Sedation-facilitatedmentioning

confidence: 99%

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Prehospital Airway Management: A Systematic Review

Carney¹,

Cheney²,

Totten³

et al. 2021

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Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation

Lewis

Butler

Parker

et al. 2016

Cochrane Database of Systematic Reviews

245

250

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Videolaryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway. They improve the glottic view and may reduce laryngeal/airway trauma. Currently, no evidence indicates that use of a VLS reduces the number of intubation attempts or the incidence of hypoxia or respiratory complications, and no evidence indicates that use of a VLS affects time required for intubation.

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