Prospective evaluation of airway management in pediatric out-of-hospital cardiac arrest

Hansen, Mitchell A.; Wang, Henry E.; Le, Nancy; Lin, Amber; Idris, Ahamed H.; Kornegay, Joshua G.; Schmicker, Robert H.; Daya, Mohamud

doi:10.1016/j.resuscitation.2020.08.003

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…A qualitative analysis of five studies (2 RCTs, 1 CCT, and 2 observational) indicated no difference in the majority of reported harms between BVM and ETI (17,(32)(33)(34)(35)(36)38). One study reported a lower rate of regurgitation for ETI compared with BVM; 7.7% difference (95% CI 4.9 to 10.4), p<0.001 (33).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…A qualitative analysis of four studies (2 RCTs and 2 observational) indicated no difference in the majority of reported harms between BVM and SGA (SOE: Moderate) (14,17,21,25). One study reported lower rates of aspiration pneumonia within 72 hours with use of BVM versus SGA (5% vs. 33%) (17).…”

Section: Data For Neurological Function Measured By the Cerebral Performance Categorymentioning

confidence: 99%

“…A qualitative analysis of seven studies (2 RCTs, 5 observational) indicated no difference between SGA versus ETI for aspiration (2 studies), oral/airway trauma (2 studies), or regurgitation (1 study). SGA was favored over ETI for multiple insertion attempts (1 study); ETI was favored over SGA for inadequate ventilation (1 study) (17,30,45,53,54,60,65). The SOE for each of these harms was moderate.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Prehospital Airway Management: A Systematic Review

Carney¹,

Totten²,

Cheney

et al. 2021

Prehospital Emergency Care

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Objective. To assess comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) used by prehospital emergency medical services (EMS) to treat patients with trauma, cardiac arrest, or medical emergencies, and how they differ based on techniques and devices, EMS personnel and patient characteristics. Data sources. We searched electronic citation databases (Ovid ® MEDLINE ® , CINAHL ® , the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus ® ) from 1990 to September 2020. Review methods. We followed Agency for Healthcare Research and Quality Effective Health Care Program Methods guidance. Outcomes included mortality, neurological function, return of spontaneous circulation (ROSC), and successful advanced airway insertion. Meta-analyses using profile-likelihood random effectsA c c e p t e d M a n u s c r i p t models were conducted, with analyses stratified by study design, emergency type, and age. Results.We included 99 studies involving 630,397 patients. We found few differences in primary outcomes across airway management approaches.For survival, there was no difference for BVM versus ETI or SGA in adult and pediatric patients with cardiac arrest or trauma. For neurological function, there was no difference for BVM versus ETI and SGA versus ETI in pediatric patients with cardiac arrest. There was no difference in BVM versus ETI in adults with cardiac arrest, but improved neurological function with BVM or ETI versus SGA. There was no difference in ROSC for patients with cardiac arrest for BVM versus ETI or SGA in adults and pediatrics, or SGA versus ETI in pediatrics.There was higher frequency of ROSC in adults with SGA versus ETI. For successful advanced airway insertion, there was higher first-pass success with SGA versus ETI for all patients except adult medical patients (no difference), and no difference in overall success using SGA versus ETI in adults.Conclusions. The currently available evidence does not indicate benefits of more invasive airway approaches based on survival, neurological function, ROSC, or successful airway insertion. Strength of evidence was low or moderate; most included studies were observational. This supports the need for high-quality randomized controlled trials to advance clinical practice and EMS education and policy, and improve patient-centered outcomes.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Data For Neurological Function Measured By the Cerebral Performance Categorymentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

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Prehospital Airway Management: A Systematic Review

Carney¹,

Totten²,

Cheney

et al. 2021

Prehospital Emergency Care

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“…Subsequent to that trial, supraglottic airway devices have influenced prehospital airway management, 17,18 but there are limited available data on prehospital supraglottic airways in children. 19,20 These observations collectively support the need for new data to inform the best practices for prehospital pediatric airway management. However, taking a traditional approach would require multiple trials conducted across a vast network of EMS systems, with a large sample size, incurring significant cost, and may still not provide a definitive answer.…”

Section: Introductionmentioning

confidence: 72%

Design of a novel clinical trial of prehospital pediatric airway management

et al. 2021

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Emergency Medical Services personnel are often the first to intervene in the care of critically ill children. Airway management is a fundamental step in prehospital resuscitation, yet there is significant variation in current prehospital airway management practices. Our objective is to present a methodologic approach to determine the optimal strategy for prehospital pediatric airway management. We describe the conceptual premise for the Pediatric Prehospital Airway Resuscitation Trial, a novel Bayesian adaptive sequential platform trial. We developed an innovative design to enable comparison of the three predominant prehospital pediatric airway techniques (bag-mask-ventilation, supraglottic airway insertion, and endotracheal intubation) in three distinct disease groups (cardiac arrest, major trauma, and other respiratory failure). We used a Bayesian statistical approach to provide flexible modeling that can adapt based on prespecified rules according to accumulating trial data with patient enrollment continuing until stopping rules are met. The approach also allows the comparison of multiple interventions in sequence across the different disease states. This Bayesian hierarchical model will be the primary analysis method for the Pediatric Prehospital Airway Resuscitation Trial. The model integrates information across subgroups, a technique known as “borrowing” to generate accurate global and subgroup-specific estimates of treatment effects and enables comparisons of airway intervention arms within the overarching trial. We will use this Bayesian hierarchical linear model that adjusts for subgroup to estimate treatment effects within each subgroup. The model will predict a patient-centered score of 30-day intensive care unit-free survival using arm, subgroup, and emergency medical services agency as predictors. The novel approach of Pediatric Prehospital Airway Resuscitation Trial will provide a feasible method to determine the optimal strategy for prehospital pediatric airway management and may transform the design of future prehospital resuscitation trials.

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“…Hansen et al, for instance, reported on airway management in 155 children, as part of a prospective observational study (2016-2018) from ten EMS agencies in 2 US metropolitan areas, showing TI still to be the most common airway management modality, despite a success rate of only 65.7%. 5 On the other hand, Nevin et al specifically looked at highly trained physician-led prehospital trauma teams and reported only a single failed TI in 315 prehospital intubations (81% RSI -19% peri-arrest). 6 Even if we do not know what 'success' really means when talking about advanced airway management nor how this relates to important outcomes, such a difference is significant.…”

mentioning

confidence: 99%

No golden eggs but …. tasteful nonetheless

Voorde

2022

Resuscitation

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Prospective evaluation of airway management in pediatric out-of-hospital cardiac arrest

Cited by 12 publications

References 23 publications

Prehospital Airway Management: A Systematic Review

Prehospital Airway Management: A Systematic Review

Design of a novel clinical trial of prehospital pediatric airway management

No golden eggs but …. tasteful nonetheless

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