Airway Management Training Might Improve Return Of Spontaneous Circulation Rate in Out-of-Hospital Cardiac Arrest...

The optimal airway management strategy in out-of-hospital cardiac arrest has been controversial. Whereas endotracheal intubation currently represents the gold standard, supraglottic airway securement may provide advantages with respect to handling out-of-hospital cardiac arrest.

This meta-analysis of randomized controlled and clinical studies evaluates the effects of the advanced airway strategy (supraglottic vs. endotracheal intubation) on return of spontaneous circulation (ROSC).

This systematic review and meta-analysis was performed based on a predefined protocol. Literature search included PubMed, Web of Science, and the Cochrane Library.

A total of eight clinical studies including 14,797 patients were analyzed. Pooled analysis indicated no higher rate of ROSC in patients treated with supraglottic airway vs. endotracheal intubation (risk difference [RD] 0.02, 95% confidence interval [CI] 0.0-0.04, p = 0.11) and no higher rate of survival to hospital discharge (RD 0.01, 95% CI -0.01-0.02, p = 0.30). Interestingly, additional training indicated a significant effect of supraglottic airway on ROSC, whereas the subgroup difference was not significant (RD [additional training] 0.02, 95% CI 0.0-0.04, p = 0.02, RD [no additional training] 0.01, 95% CI -0.05-0.01, p = 0.72, test for subgroup differences, p = 0.73). Training programs differed between the investigated studies. Statistical heterogeneity was not observed.

Overall, the type of advanced airway (supraglottic vs. endotracheal intubation) did not impact ROSC or survival to hospital discharge. However, after additional training, supraglottic airway use may have a positive effect on ROSC in out-of-hospital cardiac arrest.