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Published on: January 17, 2011
Prehospital airway management in the pediatric patient: A systematic review
Veronica K Weihing1, Ellen H Crowe1, Henry E Wang2
1McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Insights
This systematic review found insufficient evidence to definitively evaluate pediatric prehospital airway management techniques. Current research suggests endotracheal intubation (ETI) may lead to equal or worse outcomes compared to other methods, necessitating further trials.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Airway Management
Background:
- Critically ill children often require airway management for oxygenation and ventilation during resuscitation.
- Prehospital airway management is crucial for optimizing outcomes in pediatric emergencies.
Purpose of the Study:
- To systematically review and compare the efficacy of bag-valve-mask ventilation (BVM), supraglottic airway devices (SGA), and endotracheal intubation (ETI) in pediatric prehospital airway management.
Main Methods:
- Systematic review of studies comparing BVM, SGA, and ETI in pediatric patients.
- Searched Ovid MEDLINE, EMBASE, and Cochrane databases following PRISMA guidelines.
- Assessed study quality using the Newcastle-Ottawa Scale.
Main Results:
- Eight studies met inclusion criteria; most were observational.
- Four studies showed no difference in survival with ETI, while four indicated increased mortality.
- Meta-analysis was not feasible due to study heterogeneity in design, population, interventions, and outcomes.
Conclusions:
- Evidence on pediatric prehospital airway management is insufficient.
- Current research suggests ETI may have equal or worse outcomes than other airway techniques.
- Additional clinical trials are required to determine the optimal airway management strategy.
Background:
Critically ill children may require airway management to optimize delivery of oxygen and ventilation during resuscitation. We performed a systematic review of studies comparing the use of bag-valve-mask ventilation (BVM), supraglottic airway devices (SGA), and endotracheal intubation (ETI) in pediatric patients requiring prehospital airway management.
Methods:
We searched Ovid MEDLINE, EMBASE, and Cochrane databases for papers that compared SGA or ETI to BVM use in children, including studies that reported survival outcomes. We followed the Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed study quality using the Newcastle-Ottawa Scale. We compared key characteristics of the candidate papers, including inclusion criteria, definitions of airway interventions, and association with outcomes.
Results:
Of 773 studies, eight met criteria for inclusion. Only one study was a randomized controlled trial; the other seven studies were observational. Four studies compared ETI to BVM, two studies compared SGA to BVM, one study compared ETI to SGA, and two studies compared advanced airway management (AAM) to BVM. Primary outcomes varied, ranging from overall mortality and 24-h mortality to 1-month survival, hospital survival, and neurologically favorable survival. Four of the studies found no difference in survival with the use of ETI, and four found increased mortality with the use of ETI. Associations with outcomes could not be assessed by meta-analysis due to limited number of studies and the wide variation in the design, population, interventions, and outcome measures of the included studies.
Conclusions:
In this systematic review, studies of prehospital pediatric airway management varied in scope, design, and conclusions. There was insufficient evidence to evaluate efficacy of pediatric prehospital airway management; however, the current research suggests that there are equal or worse outcomes with the use of ETI compared to other airway techniques. Additional clinical trials are needed to assess the merits of this practice.
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