BComparison of supraglottic airway device vs. endotracheal intubation for initial airway management in out-of-hospital cardiac arrest: a systematic review and meta-analysis.

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is characterized by the cessation of mechanical cardiac activity and voluntary circulation occurring outside of a hospital setting, making it the leading cause of death worldwide. Recently, the optimal approach to airway management has been a subject of controversy.

Methods: Follow PRISMA guidelines for systematic evaluation and meta-analysis. The primary outcome was survival assessed by 4 measures: Restoration of spontaneous circulation, survival to hospital or emergency department, evaluation of functional recovery after PCR (measured at both discharge and 3 months after PCR), and neurological function score at discharge.

Results: A total of 6 RCTs (14,205 patients) were included in the systematic review and 4 RCTs (13,053 patients) were included in the meta-analysis. 5 studies (83.3%)of RCTs with ETI controls were notable for their high quality, with low risk of bias judged in all 7 domains of the risk assessment scale. Showed an advantage of SGA (compared to ETI) with potential for ROSC (95% CI [1.02 to 1.18], I² = 48%, p = 0.01) and survival to hospital or emergency department(95% CI [1.01 to 1.17], I² = 12%, p = 0.02).

Conclusions: This systematic review and meta-analysis found a significant association between SGA and the possibility of obtaining ROSC and reaching the hospital or emergency department after CPR in OHCA.