Evaluating the Efficacy of Pre-hospital Endotracheal Intubation in Cardiac Arrest: A Meta-Analysis.

Abstract

The optimal airway management strategy during cardiac arrest remains a subject of ongoing debate. This study aims to con-tribute to the literature on pre-hospital endotracheal intubation (ETI) during cardiac arrest by assessing its association with improved patient outcomes, specifically a higher incidence of return of spontaneous circulation (ROSC). Additionally, the study seeks to determine if ETI remains the best practice for airway management. Methods: A comprehensive literature review was conducted using the Medline Complete and CINAHL Complete databases. The PICOT formula guided the selection of search terms, and a systematic search strategy was employed. Inclusion criteria focused on English-language, peer-reviewed, full-text articles published between 2010 and 2020, with a preference for stud-ies conducted in pre-hospital settings. The search identified 78 eligible articles, with six high-quality studies included in the final analysis. Results: The included articles, primarily from the United States, Europe, the United Kingdom, and Japan, involved a total of 341,286 participants. Meta-analysis results indicated no significant difference between ETI and control groups for 96.63% of pre-hospital cardiac arrests. The study participants received either ETI or basic airway management techniques, such as bag valve masks and supraglottic airway devices. The data suggests that ETI does not provide a substantial advantage over basic airway management techniques in terms of improving patient outcomes. Conclusion: This meta-analysis supports the growing body of evidence suggesting that pre-hospital endotracheal intubation is not significantly associated with better outcomes in cardiac arrest cases compared to basic airway management tech-niques. While ETI is not linked to poorer patient outcomes, the study recommends further investigation to definitively con-firm whether pre-hospital endotracheal intubation increases a patient's chances of survival after cardiac arrest.