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Advanced airway interventions for paediatric cardiac arrest: A systematic review and meta-analysis

Eric J Lavonas1, Shinichiro Ohshimo2, Kevin Nation3

  • 1Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.

Resuscitation
|March 14, 2019
PubMed

Insights

Bag-mask ventilation (BMV) alone may be more effective than advanced airway interventions like tracheal intubation (TI) or supraglottic airway (SGA) placement for pediatric cardiac arrest resuscitation. However, evidence quality is low, necessitating further research.

Area of Science:

  • Pediatric Emergency Medicine
  • Critical Care
  • Resuscitation Science

Background:

  • Advanced airway interventions, including tracheal intubation (TI) and supraglottic airway (SGA) placement, are commonly used in pediatric cardiac arrest resuscitation.
  • The comparative effectiveness of these advanced techniques versus bag-mask ventilation (BMV) alone remains unclear.

Purpose of the Study:

  • To assess the use of advanced airway interventions (TI or SGA) compared with BMV alone for the resuscitation of children experiencing cardiac arrest.

Main Methods:

  • A systematic review and meta-analysis of human trials and observational studies published before September 24, 2018.
  • Searches were conducted in Medline, EMBASE, and Cochrane CENTRAL.
  • Study selection, data extraction, and risk of bias assessment were performed by two independent investigators using GRADE and CLARITY frameworks.

Main Results:

  • Fourteen studies were included, comprising 1 pseudorandomized trial, 3 propensity-matched observational studies, and 8 simple cohort studies.
  • The overall certainty of evidence was low to very low.
  • Results suggested better outcomes with BMV compared to TI or SGA for survival to hospital discharge with good neurological outcome; limited data favored SGA over TI.

Conclusions:

  • Advanced airway interventions (TI or SGA) are not demonstrably superior to BMV alone for pediatric cardiac arrest resuscitation.
  • The current evidence base is limited by low to very low certainty.
  • Well-designed randomized controlled trials are essential to definitively answer this critical clinical question.
Abstract

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