The following is a summary of “Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis,” published in the June 2023 issue of Emergency Medicine by Amagasa, et al.

Effective airway management is crucial in pediatric out-of-hospital cardiac arrest (OHCA) resuscitation. However, the comparative effectiveness of bag-mask ventilation (BMV) and advanced airway management (AAM) techniques like endotracheal intubation (ETI) and supraglottic airway (SGA) devices remained unclear. For a study, researchers sought to assess the efficacy of AAM in prehospital resuscitation of pediatric OHCA cases.

A systematic search of four databases was conducted from inception to November 2022. The inclusion criteria encompassed randomized controlled trials and observational studies with adequate confounder adjustments, focusing on prehospital AAM for OHCA in children under 18. Network meta-analysis, following the GRADE Working Group approach, was utilized to compare three interventions (BMV, ETI, and SGA). The primary outcomes were survival and favorable neurological outcomes at hospital discharge or one-month post-cardiac arrest.

Five studies (including one clinical trial and four rigorously adjusted cohort studies) involving 4,852 patients were included in the quantitative synthesis. When compared to ETI, BMV was associated with improved survival (relative risk [RR] 0.44 [95% CI 0.25–0.77]) (very low certainty). Other comparisons (SGA vs BMV: RR 0.62 [95% CI 0.33-1.15] [low certainty], ETI vs SGA: RR 0.71 [95% CI 0.39-1.32] [very low certainty]) did not reveal any statistically significant survival correlations. In either comparison, there were no statistically significant correlations with good neurological outcomes (ETI vs BMV: RR 0.33; 95% CI 0.11-1.02; SGA vs BMV: RR 0.50; 95% CI 0.14-1.80; ETI vs SGA: RR 0.66; 95% CI 0.18-2.46; all with very low certainty). The ranking analysis indicated that for survival and favorable neurological outcomes, the hierarchy of efficacy was BMV > SGA > ETI.

Though the evidence was primarily derived from observational studies and exhibits low to very low certainty, prehospital advanced airway management for pediatric OHCA did not significantly improve outcomes.

Source: sciencedirect.com/science/article/abs/pii/S073567572300164X