• Yangyang Tang, Mengxue Sun, and Aiqun Zhu.
• Xiangya Nursing School of Central South University, Changsha, Hunan, China.
• Am J Emerg Med. 2022 Jul 1; 57: 60-69.

BackgroundThe optimal airway management strategy for cardiac arrest remains unclear. This study aimed to compare the effects of different initial airway interventions on improving clinical outcomes based on the 2010 cardiopulmonary resuscitation (CPR) guidelines and later.MethodsWe searched PubMed, EMBASE, and the Cochrane Library for CPR articles tailored to each database from October 19, 2010, to July 31, 2021, to compare endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BMV). The initial results and long-term results were investigated by meta-analysis.ResultsTwenty-five articles (n = 196,486) were included. The ROSC rate in the ETI group (ES = 0.49, 95% CI: 0.38-0.59) was significantly higher than that in the SGA group (ES = 0.27, 95% CI: 0.20-0.34) and BMV group (ES = 0.24, 95% CI: 0.17-0.31). The rate of ROSC upon admission to the hospital in the ETI group (ES = 0.27, 95% CI: 0.13-0.42) was significantly higher than that in the SGA group (ES = 0.18, 95% CI: 0.13-0.23) and BMV group (ES = 0.16, 95% CI: 0.10-0.22). Compared with the BMV group (ES = 0.09, 95% CI: 0.04-0.14) and the SGA group (ES = 0.08, 95% CI: 0.05-0.10), the ETI group (ES = 0.14, 95% CI: 0.10-0.17) had a higher discharge rate, but all of the groups had the same neurological outcome (ETI group [ES = 0.06, 95% CI: 0.04-0.08], BMV group [ES = 0.05, 95% CI: 0.03-0.08] and SGA group [ES = 0.04, 95% CI: 0.03-0.05]).ConclusionsOpening the airway is significantly associated with improved clinical outcomes, and the findings suggest that effective ETI based on mask ventilation should be implemented as early as possible once the patient has experienced cardiac arrest.Copyright © 2022 Elsevier Inc. All rights reserved.

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