Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests

Reply to: Potential selection bias in the baseline

“…To the Editor, We thank the authors, Li Yifang et al, for their interest in our paper: Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests. 1 We agree that resuscitation time bias had been studied using time-dependent propensity score and risk-set matching in a paediatric airway management study. 2 We did not perform time-dependent propensity score matching as the data on time of advanced airway insertion was not consistently available for all patients.…”

“…The result had been reported and published as supplementary data. 1 The baseline characteristics of the propensity score matched cohort are presented in Table 1. The advanced airway management (AAM) group, consisting of patients who received endotracheal intubations (ETI) and supraglottic airways (SGA) were associated with lower survival with favourable neurological outcome (Cerebral Performance Category (CPC) 1 or 2) [AAM: 8/396 (2.0%) versus BVM: 19/396 (4.8%); adjusted odds ratio (aOR), 0.39 (95% CI 0.17-0.91); p = 0.03] though not in 1-month survival [AAM: 28/ 396 (7.1%) versus BVM: 40/396 (10.1%); aOR 0.67 (95% CI 0.41-1.12); p = 0.126] when compared with bag-valve-mask (BVM) ventilations (Table 2).…”

“…There were 282 patients that achieved pre-hospital ROSC in our study, and the data on duration of resuscitation at scene/en-route was only available for 140 patients with pre-hospital ROSC. 1 It cannot be assumed that the duration of resuscitation calculated would be representative of the whole cohort of patients that achieved prehospital ROSC. The proportions of patients that achieved pre-hospital ROSC in the AAM group was higher than in the BVM group.…”

“…However, lower 1-month survival and survival with CPC 1 or 2 was observed in the AAM group compared to BVM group for the whole unmatched cohort. 1 The median (IQR) scene time (available for 745 patients) was also longer in the patients that received AAM compared to BVM [AAM: 13 min (9-18) versus BVM: 7 min (4-11); p < 0.001]. An observational study had evaluated the effect of resuscitative time at the scene on survival outcomes and found that longer on-scene resuscitation was associated with decreased 1-month survival, adjusted for AAM and other confounders.…”

Out-of-hospital cardiac arrest in children: An epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation

“…However, as current registry variables do not support the proposed format, such a chart was not applied in our study. (2) Due to the retrospective nature of this study, it was not possible to assess causation for different interventions like airway management [2,27] or dosage of adrenaline [13].…”