• Ling Tiah, Kentaro Kajino, Omer Alsakaf, Dianne Carrol Tan Bautista, Marcus Eng Hock Ong, Desiree Lie, Ghulam Yasin Naroo, Nausheen Edwin Doctor, Michael Y C Chia, and Han Nee Gan.
• Changi General Hospital, Accident and Emergency Department, Singapore.
• West J Emerg Med. 2014 Nov 1;15(7):749-57.

IntroductionEndotracheal intubation (ETI) is currently considered superior to supraglottic airway devices (SGA) for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA). We aimed to determine if the research supports this conclusion by conducting a systematic review.MethodsWe searched the MEDLINE, Scopus and CINAHL databases for studies published between January 1, 1980, and 30 April 30, 2013, which compared pre-hospital use of ETI with SGA for outcomes of return of spontaneous circulation (ROSC); survival to hospital admission; survival to hospital discharge; and favorable neurological or functional status. We selected studies using pre-specified criteria. Included studies were independently screened for quality using the Newcastle-Ottawa scale. We did not pool results because of study variability. Study outcomes were extracted and results presented as summed odds ratios with 95% CI.ResultsWe identified five eligible studies: one quasi-randomized controlled trial and four cohort studies, involving 303,348 patients in total. Only three of the five studies reported a higher proportion of ROSC with ETI versus SGA with no difference reported in the remaining two. None found significant differences between ETI and SGA for survival to hospital admission or discharge. One study reported better functional status at discharge for ETI versus SGA. Two studies reported no significant difference for favorable neurological status between ETI and SGA.ConclusionCurrent evidence does not conclusively support the superiority of ETI over SGA for multiple outcomes among adults with OHCA.

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