Abstract 46: Meta-analysis of Endotracheal Intubation Versus Supraglottic Airway Placement by Emergency Medical Services During Out-of-Hospital Cardiac Arrest
Objective: Patients frequently undergo advanced airway management during out of hospital cardiac arrest (OHCA) resuscitation attempts. Recent observational data has associated endotracheal intubation (ETI) with worse outcomes and unacceptable failure rates. Supraglottic airways (SGA) are easier to insert, but the comparative effectiveness of this intervention is unclear. The objective of this study was to analyze all available data comparing patient outcomes for these two airway methods in OHCA patients treated by emergency medical services (EMS).
Methods: A dual-reviewer search was conducted in PubMed, Embase, and the Cochrane Database with a research librarian to identify all relevant peer-reviewed articles. Exclusion criteria were traumatic arrests, pediatric patients, physician/nurse intubators, rapid sequence intubation, video devices, devices solely obstructing the esophagus, and studies using identical datasets. Outcomes were evaluated in two categories: (1) Early survival (return of spontaneous circulation or survival to hospital admission), and (2) Late survival (survival to discharge or neurologically intact survival). Results were summarized using odds ratios and combined using meta-analytic techniques, Cochran’s Q test, and the random effects model.
Results: From 3,454 titles, we reviewed 325 abstracts, yielding 5 observational studies that fulfilled all criteria, with 60,635 ETI patients and 246,506 SGA patients. Important covariates such as age, gender, initial cardiac rhythm, witness status, and bystander CPR, were similar between patient groups in all studies. Significant study-level heterogeneity was present for both early survival (I2 = 87.3%, p < 0.001) and late survival (I2 = 66.1%, p = 0.001). Patients who received ETI had statistically significant higher odds of early survival (odds ratio 1.37, 95% confidence interval 1.04-1.81) but similar odds of late survival (odds ratio 1.17, 95% confidence interval 0.86-1.61) compared to SGA.
Conclusion: Patients with OHCA treated by EMS are more likely to achieve return of spontaneous circulation or survive to admission after ETI compared to SGA, but this does not change ultimate survival. A randomized control trial is needed to further evaluate these associations.
- Cardiac arrest
- Emergency medical services (EMS)
- Cardiopulmonary resuscitation
- Return of spontaneous circulation (ROSC)
- Sudden cardiac death
Author Disclosures: J.L. Benoit: None. R.B. Gerecht: None. M.T. Steuerwald: None. J.T. McMullan: None.
- © 2014 by American Heart Association, Inc.