Abstract
Aim
To systematically review the literature on advanced airway management during adult
cardiac arrest in order to inform the International Liaison Committee of Resuscitation
(ILCOR) consensus on science and treatment recommendations.
Methods
The review was performed according to PRISMA guidelines and registered on PROSPERO
(CRD42018115556). We searched Medline, Embase, and Evidence-Based Medicine Reviews
for controlled trials and observational studies published before October 30, 2018.
The population included adult patients with cardiac arrest. Two investigators reviewed
studies for relevance, extracted data, and assessed the risk of bias of individual
studies.
Results
We included 78 observational studies and 11 controlled trials. Most of the observational
studies and all of the controlled trials only included patients with out-of-hospital
cardiac arrest. The risk of bias for individual observational studies was overall
assessed as critical or serious, with confounding and selection bias being the primary
sources of bias. Three of the controlled trials, all published in 2018, were powered
for clinical outcomes with two comparing a supraglottic airway to tracheal intubation
and one comparing bag-mask ventilation to tracheal intubation. All three trials had
some concerns regarding risk of bias primarily due to lack of blinding and variable
adherence to the protocol. Clinical and methodological heterogeneity across studies,
for both the observational studies and the controlled trials, precluded any meaningful
meta-analyses.
Conclusions
We identified a large number of studies related to advanced airway management in adult
cardiac arrest. Three recently published, large randomized trials in out-of-hospital
cardiac arrest will help to inform future guidelines. Trials of advanced airway management
during in-hospital cardiac arrest are lacking.
Keywords
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Article info
Publication history
Published online: April 11, 2019
Accepted:
April 2,
2019
Received in revised form:
March 29,
2019
Received:
March 18,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
