• Lai Peng Tham, Stephanie Fook-Chong, Nur Shahidah Binte Ahmad, HoAndrew Fu-WahAFDepartment of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centr, Hideharu Tanaka, Sang Do Shin, Patrick Chow-In Ko, Kwanhathai Darin Wong, Supasaowapak Jirapong, RaoG V RamanaGVRGVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India., Wenwei Cai, Saad Al Qahtani, OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore., and Pan-Asian Resuscitation Outcomes Study Clinical Research Network.
• Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore. Electronic address: tham.lai.peng@singhealth.com.sg.
• Resuscitation. 2022 Jul 1; 176: 9-18.

BackgroundPaediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region.MethodsWe performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort.ResultsWe included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95 %CI, 0.25-0.69), p = 0.001] and survival with favourable neurological status.ConclusionIn children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.Copyright © 2022 Elsevier B.V. All rights reserved.

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