Different airway management strategies in out-of-hospital cardiac arrest: a systematic review_West China Medical Journal

Authors：

JIN Rui ¹ , CAO Jingshi ¹ , LI Ruixin ¹ , LIU Junzhao ¹ , YE Sheng ¹ , WENG Shanshan ¹ ,  CAO Yu ^1,2,3

1. Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Disaster Medical Center, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CAO Yu, Email: yuyuer@126.com

Keywords：

Cardiac arrest; Airway management strategy; Emergency medical service; Endotracheal intubation; Supraglottic airway; Bag-valve mask; Systematic review

DOI：

10.7507/1002-0179.201910110

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Objective To compare the effects of different airway management strategies on outcomes of patients with out-of-hospital cardiac arrest (OHCA).Methods We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and WanFang Data for relevant studies comparing the influence of different airway management strategies on outcomes of OHCA patients. The deadline was up to 31st May, 2019. Grading of Recommendations Assessment, Development and Evaluation system 3.6 was used for quality assessment, and RevMan 5.3 software was used for meta-analysis. Odds ratio (OR) and 95% confidence interval (CI) were used to conduct the comparison. Results A total of 20 studies were finally enrolled, including 880 567 OHCA patients. Compared with supraglottic airway (SGA), bag-valve mask (BVM) improved the rate of survival to discharge of OHCA patients [OR=1.45, 95%CI (1.01, 2.08), P=0.04], while the rate of return of spontaneous circulation (ROSC) was not improved (P>0.05); in the subgroup analysis, BVM and SGA had similar effect on the rate of ROSC and the rate of survival to discharge in Asian countries (P>0.05), while BVM performed better than SGA in the two rates in European and American countries. BVM and endotracheal intubation (ETI) had similar effect on the two rates (P>0.05). In Asian countries, ETI performed better than BVM in the rate of ROSC [OR=0.63, 95%CI (0.49, 0.81), P=0.000 3], and there was no statistically significant difference in the rate of survival to discharge between ETI and BVM (P>0.05); while in European andAmerican countries, BVM performed better than ETI in the rate of survival to discharge [OR=3.10, 95%CI (2.69, 3.56), P<0.000 01], and there was no statistically significant difference in the rate of ROSC between ETI and BVM (P>0.05). Compared with SGA, ETI improved the rate of ROSC [OR=0.68, 95%CI (0.62, 0.76), P<0.000 01] and the rate of survival to discharge [OR=0.89, 95%CI (0.81, 0.98), P=0.02]. In Asian countries, ETI performed better than SGA in the two rates (P<0.05); while in European and American countries and New Zealand, ETI performed better than SGA in the rate of ROSC (P<0.05), but there was no statistically significant difference in the rate of survival to discharge (P>0.05). Conclusions Different airway management strategies have differente effects on OHCA patients. The optimal airway management strategy when rescuing OHCA patients might be selected based on local emergency medical service system conditions.

Citation： JIN Rui, CAO Jingshi, LI Ruixin, LIU Junzhao, YE Sheng, WENG Shanshan, CAO Yu. Different airway management strategies in out-of-hospital cardiac arrest: a systematic review. West China Medical Journal, 2019, 34(11): 1251-1260. doi: 10.7507/1002-0179.201910110 Copy

1.	Chan PS, Mcnally B, Tang F, et al. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation, 2014, 130(21): 1876-1882.
2.	Shao F, Li CS, Liang LR, et al. Outcome of out-of-hospital cardiac arrests in Beijing, China. Resuscitation, 2014, 85(11): 1411-1417.
3.	McMullan J, Gerecht R, Bonomo J, et al. Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation, 2014, 85(5): 617-622.
4.	Stiell I. Advanced cardiac life support in out-of-hospital cardiac arrest. ACC Curr J Rev, 2004, 13(11): 63-64.
5.	Wang HE, Mann NC, Mears G, et al. Out-of-hospital airway management in the United States. Resuscitation, 2011, 82(4): 378-385.
6.	Wang HE, Balasubramani GK, Cook LJ, et al. Out-of-hospital endotracheal intubation experience and patient outcomes. Ann Emerg Med, 2010, 55(6): 527-537.e6.
7.	Balshem H, Helfanda M, Schunemann HJ, et al. GRADE指南: Ⅲ.证据质量分级. 李幼平, 杨晓妍, 高霑, 译. 中国循证医学杂志, 2011, 11(4): 451-455.
8.	Shin SD, Ahn KO, Song KJ, et al. Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis. Resuscitation, 2012, 83(3): 313-319.
9.	Mulder PJ, Oetomo SB, Vloet L, et al. Comparison in effectiveness and safety between a supraglottic airway device and endotracheal intubation in out-of-hospital cardiac arrest in the Netherlands. Resuscitation, 2013, 62(4, S): S45.
10.	Cady CE, Weaver MD, Pirrallo RG, et al. Effect of emergency medical technician-placed combitubes on outcomes after out-of-hospital cardiopulmonary arrest. Prehosp Emerg Care, 2009, 13(4): 495-499.
11.	Wang HE, Schmicker RH, Daya MR, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial. JAMA, 2018, 320(8): 769-778.
12.	Benger JR, Kirby K, Black S, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial. JAMA, 2018, 320(8): 779-791.
13.	Yanagawa Y, Sakamoto T. Analysis of prehospital care for cardiac arrest in an urban setting in Japan. J Emerg Med, 2010, 38(3): 340-345.
14.	Tanabe S, Ogawa T, Akahane M, et al. Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study. J Emerg Med, 2013, 44(2): 389-397.
15.	Nagao T, Kinoshita K, Sakurai A, et al. Effects of bag-mask versus advanced airway ventilation for patients undergoing prolonged cardiopulmonary resuscitation in pre-hospital setting. J Emerg Med, 2012, 42(2): 162-170.
16.	Takei Y, Enami M, Yachida T, et al. Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin. J Anesth, 2010, 24(5): 716-725.
17.	Davey P, Dicker B. Outcome comparison between endotracheal intubation and laryngeal mask airway use in out-of-hospital cardiac arrest: a New Zealand registry study. Heart Lung Circ, 2016, 25: S8.
18.	Sulzgruber P, Datler P, Sterz F, et al. The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: a propensity score matched analysis. Eur Heart J Acute Cardiovasc Care, 2018, 7(5): 423-431.
19.	Kajino K, Iwami T, Kitamura T, et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care, 2011, 15(5): R236.
20.	Chiang WC, Hsieh MJ, Chu HL, et al. The effect of successful intubation on patient outcomes after out-of-hospital cardiac arrest in Taipei. Ann Emerg Med, 2018, 71(3): 387-396.e2.
21.	Kang K, Kim T, Ro YS, et al. Prehospital endotracheal intubation and survival after out-of-hospital cardiac arrest: results from the Korean nationwide registry. Am J Emerg Med, 2016, 34(2): 128-132.
22.	Hanif MA, Kaji AH, Niemann JT. Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Acad Emerg Med, 2010, 17(9): 926-931.
23.	Hasegawa K, Hiraide A, Chang Y, et al. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA, 2013, 309(3): 257-266.
24.	Lin SC, Hsu SC, Weng YM, et al. Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?. Signa Vitae, 2014, 9(1): 1-6.
25.	姚晓丽, 金培英, 翁伟芬, 等. 插管型喉罩与常规复苏面罩在院前急救中应用的效果比较. 护理与康复, 2015, 10(14): 953-954.
26.	肖峥, 颜小明, 吴佳乐, 等. 喉罩在院前急救呼吸骤停患者中的应用. 实用临床医学, 2014, 8(15): 23-25.
27.	Nikolla D, Lewandowski T, Carlson J. Mitigating hyperventilation during cardiopulmonary resuscitation. Am J Emerg Med, 2016, 34(3): 643-646.
28.	Pitts S, Kellermann AL. Hyperventilation during cardiac arrest. Lancet, 2004, 364(9431): 313-315.
29.	Maertens VL, De Smedt LE, Lemoyne S, et al. Patients with cardiac arrest are ventilated two times faster than guidelines recommend: an observational prehospital study using tracheal pressure measurement. Resuscitation, 2013, 84(7): 921-926.
30.	Cone DC, Middleton PR. Paper, scissors: tracheal intubation or supraglottic airway for out-of-hospital cardiac arrest?. Resuscitation, 2012, 83(9): 1047-1048.
31.	Diggs LA, Yusuf JE, De Leo G. An update on out-of-hospital airway management practices in the United States. Resuscitation, 2014, 85(7): 885-892.
32.	Kamiutsuri K, Okutani R, Kozawa S. Analysis of prehospital endotracheal intubation performed by emergency physicians: retrospective survey of a single emergency medical center in Japan. J Anesth, 2013, 27(3): 374-379.

1. Chan PS, Mcnally B, Tang F, et al. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation, 2014, 130(21): 1876-1882.
2. Shao F, Li CS, Liang LR, et al. Outcome of out-of-hospital cardiac arrests in Beijing, China. Resuscitation, 2014, 85(11): 1411-1417.
3. McMullan J, Gerecht R, Bonomo J, et al. Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation, 2014, 85(5): 617-622.
4. Stiell I. Advanced cardiac life support in out-of-hospital cardiac arrest. ACC Curr J Rev, 2004, 13(11): 63-64.
5. Wang HE, Mann NC, Mears G, et al. Out-of-hospital airway management in the United States. Resuscitation, 2011, 82(4): 378-385.
6. Wang HE, Balasubramani GK, Cook LJ, et al. Out-of-hospital endotracheal intubation experience and patient outcomes. Ann Emerg Med, 2010, 55(6): 527-537.e6.
7. Balshem H, Helfanda M, Schunemann HJ, et al. GRADE指南: Ⅲ.证据质量分级. 李幼平, 杨晓妍, 高霑, 译. 中国循证医学杂志, 2011, 11(4): 451-455.
8. Shin SD, Ahn KO, Song KJ, et al. Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis. Resuscitation, 2012, 83(3): 313-319.
9. Mulder PJ, Oetomo SB, Vloet L, et al. Comparison in effectiveness and safety between a supraglottic airway device and endotracheal intubation in out-of-hospital cardiac arrest in the Netherlands. Resuscitation, 2013, 62(4, S): S45.
10. Cady CE, Weaver MD, Pirrallo RG, et al. Effect of emergency medical technician-placed combitubes on outcomes after out-of-hospital cardiopulmonary arrest. Prehosp Emerg Care, 2009, 13(4): 495-499.
11. Wang HE, Schmicker RH, Daya MR, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial. JAMA, 2018, 320(8): 769-778.
12. Benger JR, Kirby K, Black S, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial. JAMA, 2018, 320(8): 779-791.
13. Yanagawa Y, Sakamoto T. Analysis of prehospital care for cardiac arrest in an urban setting in Japan. J Emerg Med, 2010, 38(3): 340-345.
14. Tanabe S, Ogawa T, Akahane M, et al. Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study. J Emerg Med, 2013, 44(2): 389-397.
15. Nagao T, Kinoshita K, Sakurai A, et al. Effects of bag-mask versus advanced airway ventilation for patients undergoing prolonged cardiopulmonary resuscitation in pre-hospital setting. J Emerg Med, 2012, 42(2): 162-170.
16. Takei Y, Enami M, Yachida T, et al. Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin. J Anesth, 2010, 24(5): 716-725.
17. Davey P, Dicker B. Outcome comparison between endotracheal intubation and laryngeal mask airway use in out-of-hospital cardiac arrest: a New Zealand registry study. Heart Lung Circ, 2016, 25: S8.
18. Sulzgruber P, Datler P, Sterz F, et al. The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: a propensity score matched analysis. Eur Heart J Acute Cardiovasc Care, 2018, 7(5): 423-431.
19. Kajino K, Iwami T, Kitamura T, et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care, 2011, 15(5): R236.
20. Chiang WC, Hsieh MJ, Chu HL, et al. The effect of successful intubation on patient outcomes after out-of-hospital cardiac arrest in Taipei. Ann Emerg Med, 2018, 71(3): 387-396.e2.
21. Kang K, Kim T, Ro YS, et al. Prehospital endotracheal intubation and survival after out-of-hospital cardiac arrest: results from the Korean nationwide registry. Am J Emerg Med, 2016, 34(2): 128-132.
22. Hanif MA, Kaji AH, Niemann JT. Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Acad Emerg Med, 2010, 17(9): 926-931.
23. Hasegawa K, Hiraide A, Chang Y, et al. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA, 2013, 309(3): 257-266.
24. Lin SC, Hsu SC, Weng YM, et al. Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?. Signa Vitae, 2014, 9(1): 1-6.
25. 姚晓丽, 金培英, 翁伟芬, 等. 插管型喉罩与常规复苏面罩在院前急救中应用的效果比较. 护理与康复, 2015, 10(14): 953-954.
26. 肖峥, 颜小明, 吴佳乐, 等. 喉罩在院前急救呼吸骤停患者中的应用. 实用临床医学, 2014, 8(15): 23-25.
27. Nikolla D, Lewandowski T, Carlson J. Mitigating hyperventilation during cardiopulmonary resuscitation. Am J Emerg Med, 2016, 34(3): 643-646.
28. Pitts S, Kellermann AL. Hyperventilation during cardiac arrest. Lancet, 2004, 364(9431): 313-315.
29. Maertens VL, De Smedt LE, Lemoyne S, et al. Patients with cardiac arrest are ventilated two times faster than guidelines recommend: an observational prehospital study using tracheal pressure measurement. Resuscitation, 2013, 84(7): 921-926.
30. Cone DC, Middleton PR. Paper, scissors: tracheal intubation or supraglottic airway for out-of-hospital cardiac arrest?. Resuscitation, 2012, 83(9): 1047-1048.
31. Diggs LA, Yusuf JE, De Leo G. An update on out-of-hospital airway management practices in the United States. Resuscitation, 2014, 85(7): 885-892.
32. Kamiutsuri K, Okutani R, Kozawa S. Analysis of prehospital endotracheal intubation performed by emergency physicians: retrospective survey of a single emergency medical center in Japan. J Anesth, 2013, 27(3): 374-379.

West China Medical Journal

Different airway management strategies in out-of-hospital cardiac arrest: a systematic review

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