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Prehospital Airway Management: A Systematic Review.
Prehospital Emergency Care
|June 11, 2021
Summary
Prehospital airway management using bag valve mask (BVM), supraglottic airway (SGA), or endotracheal intubation (ETI) showed no significant differences in survival or neurological outcomes. Current evidence does not support more invasive approaches for these patient groups.
Area of Science:
- Emergency Medicine
- Critical Care
- Airway Management
Background:
- Prehospital emergency medical services (EMS) utilize various airway management techniques, including bag valve mask (BVM), supraglottic airway (SGA), and endotracheal intubation (ETI).
- Comparative effectiveness and safety data for these approaches in diverse patient populations (trauma, cardiac arrest, medical emergencies) are crucial for optimizing patient care.
Purpose of the Study:
- To compare the benefits and harms of BVM, SGA, and ETI in prehospital settings.
- To analyze differences based on techniques, devices, EMS personnel, and patient characteristics.
Main Methods:
- Systematic review and meta-analysis of 99 studies involving 630,397 patients, published from 1990 to September 2020.
- Outcomes assessed included mortality, neurological function, return of spontaneous circulation (ROSC), and successful advanced airway insertion.
- Analyses were stratified by study design, emergency type, and age, following Agency for Healthcare Research and Quality guidance.
Main Results:
- No significant differences in survival were found for BVM versus ETI or SGA in adult and pediatric cardiac arrest or trauma patients.
- Neurological function showed no difference for BVM versus ETI or SGA versus ETI in pediatric cardiac arrest, but improved with BVM/ETI over SGA in adult cardiac arrest.
- Return of spontaneous circulation (ROSC) rates were similar across approaches, with higher ROSC for SGA versus ETI in adults; first-pass success was higher for SGA versus ETI, except in adult medical patients.
Conclusions:
- Current evidence does not demonstrate superior benefits of more invasive airway approaches (SGA, ETI) over BVM in terms of survival, neurological function, ROSC, or successful insertion.
- The low to moderate strength of evidence, primarily from observational studies, highlights the need for high-quality randomized controlled trials.
- Future research should focus on improving patient-centered outcomes and informing EMS education, policy, and clinical practice.
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