• Ben Forestell, Sophie Ramsden, Sameer Sharif, John Centofanti, Al LawatiKumaitKDivision of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada., Shannon M Fernando, Michelle Welsford, Graham Nichol, Jerry P Nolan, and Bram Rochwerg.
• Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
• Crit. Care Med. 2024 Feb 1; 52 (2): e89e99e89-e99.

ObjectivesGiven the uncertainty regarding the optimal approach for airway management for adult patients with out-of-hospital cardiac arrest (OHCA), we conducted a systematic review and meta-analysis to compare the use of supraglottic airways (SGAs) with tracheal intubation for initial airway management in OHCA.Data SourcesWe searched MEDLINE, PubMed, Embase, Cochrane Library, as well as unpublished sources, from inception to February 7, 2023.Study SelectionWe included randomized controlled trials (RCTs) of adult OHCA patients randomized to SGA compared with tracheal intubation for initial prehospital airway management.Data ExtractionReviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model. We used the modified Cochrane risk of bias 2 tool and assessed certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We preregistered the protocol on PROSPERO (CRD42022342935).Data SynthesisWe included four RCTs ( n = 13,412 patients). Compared with tracheal intubation , SGA use probably increases return of spontaneous circulation (ROSC) (relative risk [RR] 1.09; 95% CI, 1.02-1.15; moderate certainty) and leads to a faster time to airway placement (mean difference 2.5 min less; 95% CI, 1.6-3.4 min less; high certainty). SGA use may have no effect on survival at longest follow-up (RR 1.06; 95% CI, 0.84-1.34; low certainty), has an uncertain effect on survival with good functional outcome (RR 1.11; 95% CI, 0.82-1.50; very low certainty), and may have no effect on risk of aspiration (RR 1.04; 95% CI, 0.94 to 1.16; low certainty).ConclusionsIn adult patients with OHCA, compared with tracheal intubation, the use of SGA for initial airway management probably leads to more ROSC, and faster time to airway placement, but may have no effect on longer-term survival outcomes or aspiration events.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

29 keywords...

hide…