Abstract
Aim
To assess the use of advanced airway interventions (tracheal intubation (TI) or supraglottic
airway (SGA) placement), compared with bag mask ventilation (BMV) alone, for resuscitation
of children in cardiac arrest.
Methods
We searched Medline, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL)
for human trials and observational studies published before September 24, 2018 for
clinical trials and observational studies with a comparison group. Two investigators
reviewed studies for relevance, extracted data, and assessed risk of bias using the
GRADE and CLARITY frameworks. Study authors were contacted when necessary to obtain
additional data. Critically important outcomes included survival to hospital discharge
and survival with good neurological outcome.
Results
We identified 14 studies, including 1 pseudorandomised clinical trial, 3 observational
cohort studies using propensity matching, and 8 simple cohort studies suitable for
meta-analysis. The overall certainty of evidence was low to very low. For the critically
important outcomes of survival to hospital discharge with good neurologic outcome
and survival to hospital discharge results suggested better outcomes achieved with
BMV than either TI or SGA; limited data favored SGA over TI. The majority of studies
involved out-of-hospital cardiac arrest, with few studies of in-hospital cardiac arrest.
Conclusions
TI or SGA are not superior to BMV for resuscitation of children in cardiac arrest,
but the overall certainty of evidence is low to very low. Well designed randomised
efficacy trials are needed to address this important question.
Abbreviations:
AAW (advanced airway), ALS (advanced life support), aOR (adjusted odds ratio), BMV (bag mask ventilation), CI (95% confidence interval), CPR (cardiopulmonary resuscitation), GRADE (Grading of Recommendations Assessment, Development, and Evaluation), IHCA (in hospital cardiac arrest), ILCOR (International Liaison Committee on Resuscitation), M–H (Cochran–Mantel–Haenszel), OHCA (out of hospital cardiac arrest), SGA (supraglottic airway), TI (tracheal intubation), RD (risk difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 09, 2019
Accepted:
February 26,
2019
Received in revised form:
February 19,
2019
Received:
January 8,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
