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A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database

Matthew L Hansen1, Amber Lin1, Carl Eriksson2

  • 1Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, United States.

Resuscitation
|August 26, 2017
PubMed

Insights

Bag-valve-mask ventilation (BVM) showed higher survival rates for pediatric out-of-hospital cardiac arrest (OHCA) patients compared to supraglottic airway (SGA) and endotracheal intubation (ETI). Further research is recommended to confirm these findings in OHCA survival outcomes.

Area of Science:

  • Pediatric Emergency Medicine
  • Cardiovascular Research
  • Resuscitation Science

Background:

  • Out-of-hospital cardiac arrest (OHCA) in children presents unique challenges.
  • Airway management is a critical component of pediatric resuscitation.
  • Comparing different airway strategies is essential for improving survival rates.

Purpose of the Study:

  • To compare the odds of survival to hospital discharge among pediatric OHCA patients.
  • To evaluate the effectiveness of bag-valve-mask ventilation (BVM), supraglottic airway (SGA), and endotracheal intubation (ETI).
  • To adjust for the propensity of receiving a specific airway intervention.

Main Methods:

  • Retrospective cohort study utilizing the Cardiac Arrest Registry to Enhance Survival (CARES) database (2011-2015).
  • Inclusion of pediatric patients (<18 years) with non-traumatic OHCA receiving Emergency Medical Services (EMS) resuscitation.
  • Propensity score analysis to compare survival outcomes for BVM, ETI, and SGA.

Main Results:

  • Analysis included 1724 pediatric OHCA cases from EMS agencies using all three airway devices.
  • Bag-valve-mask ventilation (BVM) was associated with higher survival to hospital discharge compared to endotracheal intubation (ETI) (OR 0.39) and supraglottic airway (SGA) (OR 0.32).
  • Findings were robust across sensitivity analyses, including complete case, EMS-agency matched, and age-stratified analyses.

Conclusions:

  • Bag-valve-mask ventilation (BVM) demonstrated a statistically significant association with higher survival to hospital discharge in pediatric OHCA patients compared to ETI and SGA.
  • The study highlights potential differences in airway management effectiveness for pediatric OHCA.
  • A large-scale randomized clinical trial is warranted to definitively confirm these findings and guide clinical practice.
Abstract

Keywords:
Airway managementEmergency medical services for childrenOut-of-hospital cardiac arrestPediatrics

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