Influence of prehospital airway management on neurological outcome in patients transferred to a heart attack centre following out‐of‐hospital cardiac arrest

Edwards, Timothy; Williams, Julia; Cottee, Michaela

doi:10.1111/1742-6723.13107

Cited by 8 publications

(5 citation statements)

References 23 publications

(30 reference statements)

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%

“…26 In the case of adult trauma patients, an RCT with 299 patients reported no difference 39 while two observational studies involving 1,029 patients when combined favored BVM, reporting lower rates of survival with ETI. 41,42 As only one retrospective cohort study of pediatric trauma patients was identified that reported survival, and it was rated as high risk of bias, 40 the evidence was insufficient to support a conclusion.…”

Section: Survivalmentioning

confidence: 99%

See 3 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%

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

show abstract

“…However, significant differences could not be found in patients with TI or SGA in retrospective or prospective studies. In a study that retrospectively analysed ambulance records between 2013 and 2014, the data of 209 patients revealed no difference in terms of neurological outcome [ 46 ].…”

Section: Clinical Studiesmentioning

confidence: 99%

Advanced airway management in out-of-hospital cardiac arrest – to intubate or not to intubate: a narrative review of the existing literature

Saraçoğlu¹,

Saraçoğlu²

2020

ait

View full text Add to dashboard Cite

Restoring partial flow of oxygenated blood is a fundamental goal of cardiopulmonary resuscitation. The ideal devices used for this purpose should have features such as low incidence of complications, high survival rate, rapid control of the airway, and adequate ventilation. Besides limiting the frequency and duration of interruptions in chest compressions, they can improve the survival and clinical outcomes of return of spontaneous circulation during cardiopulmonary resuscitation. The overall rates of survival from out-of-hospital cardiac arrest have improved dramatically in recent years. However, optimal airway management during out-of-hospital cardiac arrest is a controversial issue. The proposed standard of care, i.e. endotracheal intubation, may have paradoxical adverse effects on intended outcomes by interrupting cardiopulmonary resuscitation and by reduction of coronary and cerebral perfusion pressure during resuscitation. The aim of this narrative review is to provide health care providers with an overview of relevant studies in the area, with a focus on alternative advanced airway techniques.

show abstract