Advanced airway management during adult cardiac arrest: a systematic review

Asger Granfeldt, Suzanne R. Avis, Tonia C. Nicholson, Mathias J. Holmberg, Ari Moskowitz, Amin Coker, Katherine M. Berg, Michael J. Parr, Michael W. Donnino, Jasmeet Soar, Kevin Nation, Lars W. Andersen, International Liaison Committee on Resuscitation Advanced Life Support Task Force Collaborators, Clifton W. Callaway, Bernd W. Böttiger, Edison F. Paiva, Tzong Luen Wang, Brian J. O'Neil, Peter T. Morley, Michelle Welsford & 7 others Ian R. Drennan, Joshua C. Reynolds, Robert W. Neumar, Claudio Sandroni, Charles D. Deakin, Jerry P. Nolan, Peter T. Mo rley

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Aim: To systematically review the literature on advanced airway management during adult cardiac arrest in order to inform the International Liaison Committee of Resuscitation (ILCOR) consensus on science and treatment recommendations. Methods: The review was performed according to PRISMA guidelines and registered on PROSPERO (CRD42018115556). We searched Medline, Embase, and Evidence-Based Medicine Reviews for controlled trials and observational studies published before October 30, 2018. The population included adult patients with cardiac arrest. Two investigators reviewed studies for relevance, extracted data, and assessed the risk of bias of individual studies. Results: We included 78 observational studies and 11 controlled trials. Most of the observational studies and all of the controlled trials only included patients with out-of-hospital cardiac arrest. The risk of bias for individual observational studies was overall assessed as critical or serious, with confounding and selection bias being the primary sources of bias. Three of the controlled trials, all published in 2018, were powered for clinical outcomes with two comparing a supraglottic airway to tracheal intubation and one comparing bag-mask ventilation to tracheal intubation. All three trials had some concerns regarding risk of bias primarily due to lack of blinding and variable adherence to the protocol. Clinical and methodological heterogeneity across studies, for both the observational studies and the controlled trials, precluded any meaningful meta-analyses. Conclusions: We identified a large number of studies related to advanced airway management in adult cardiac arrest. Three recently published, large randomized trials in out-of-hospital cardiac arrest will help to inform future guidelines. Trials of advanced airway management during in-hospital cardiac arrest are lacking.

LanguageEnglish
Pages133-143
Number of pages11
JournalResuscitation
Volume139
DOIs
Publication statusPublished - 1 Jun 2019
Externally publishedYes

Fingerprint

Airway Management
Heart Arrest
Observational Studies
Out-of-Hospital Cardiac Arrest
Intubation
Guidelines
Selection Bias
Evidence-Based Medicine
Masks
Resuscitation
Meta-Analysis
Research Personnel
Population

Keywords

  • Airway
  • Bag-mask
  • Cardiac arrest
  • ILCOR
  • Intubation
  • Supraglottic

Cite this

Granfeldt, A., Avis, S. R., Nicholson, T. C., Holmberg, M. J., Moskowitz, A., Coker, A., ... International Liaison Committee on Resuscitation Advanced Life Support Task Force Collaborators (2019). Advanced airway management during adult cardiac arrest: a systematic review. Resuscitation, 139, 133-143. https://doi.org/10.1016/j.resuscitation.2019.04.003
Granfeldt, Asger ; Avis, Suzanne R. ; Nicholson, Tonia C. ; Holmberg, Mathias J. ; Moskowitz, Ari ; Coker, Amin ; Berg, Katherine M. ; Donnino, Michael W. ; Soar, Jasmeet ; Nation, Kevin ; Andersen, Lars W. ; International Liaison Committee on Resuscitation Advanced Life Support Task Force Collaborators. / Advanced airway management during adult cardiac arrest : a systematic review. In: Resuscitation. 2019 ; Vol. 139. pp. 133-143.
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Granfeldt, A, Avis, SR, Nicholson, TC, Holmberg, MJ, Moskowitz, A, Coker, A, Berg, KM, Donnino, MW, Soar, J, Nation, K, Andersen, LW & International Liaison Committee on Resuscitation Advanced Life Support Task Force Collaborators 2019, 'Advanced airway management during adult cardiac arrest: a systematic review', Resuscitation, vol. 139, pp. 133-143. https://doi.org/10.1016/j.resuscitation.2019.04.003

Advanced airway management during adult cardiac arrest : a systematic review. / Granfeldt, Asger; Avis, Suzanne R.; Nicholson, Tonia C.; Holmberg, Mathias J.; Moskowitz, Ari; Coker, Amin; Berg, Katherine M.; Donnino, Michael W.; Soar, Jasmeet; Nation, Kevin; Andersen, Lars W.; International Liaison Committee on Resuscitation Advanced Life Support Task Force Collaborators.

In: Resuscitation, Vol. 139, 01.06.2019, p. 133-143.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Advanced airway management during adult cardiac arrest

T2 - Resuscitation

AU - Granfeldt, Asger

AU - Avis, Suzanne R.

AU - Nicholson, Tonia C.

AU - Holmberg, Mathias J.

AU - Moskowitz, Ari

AU - Coker, Amin

AU - Berg, Katherine M.

AU - Parr, Michael J.

AU - Donnino, Michael W.

AU - Soar, Jasmeet

AU - Nation, Kevin

AU - Andersen, Lars W.

AU - International Liaison Committee on Resuscitation Advanced Life Support Task Force Collaborators

AU - Callaway, Clifton W.

AU - Böttiger, Bernd W.

AU - Paiva, Edison F.

AU - Wang, Tzong Luen

AU - O'Neil, Brian J.

AU - Morley, Peter T.

AU - Welsford, Michelle

AU - Drennan, Ian R.

AU - Reynolds, Joshua C.

AU - Neumar, Robert W.

AU - Sandroni, Claudio

AU - Deakin, Charles D.

AU - Nolan, Jerry P.

AU - Mo rley, Peter T.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Aim: To systematically review the literature on advanced airway management during adult cardiac arrest in order to inform the International Liaison Committee of Resuscitation (ILCOR) consensus on science and treatment recommendations. Methods: The review was performed according to PRISMA guidelines and registered on PROSPERO (CRD42018115556). We searched Medline, Embase, and Evidence-Based Medicine Reviews for controlled trials and observational studies published before October 30, 2018. The population included adult patients with cardiac arrest. Two investigators reviewed studies for relevance, extracted data, and assessed the risk of bias of individual studies. Results: We included 78 observational studies and 11 controlled trials. Most of the observational studies and all of the controlled trials only included patients with out-of-hospital cardiac arrest. The risk of bias for individual observational studies was overall assessed as critical or serious, with confounding and selection bias being the primary sources of bias. Three of the controlled trials, all published in 2018, were powered for clinical outcomes with two comparing a supraglottic airway to tracheal intubation and one comparing bag-mask ventilation to tracheal intubation. All three trials had some concerns regarding risk of bias primarily due to lack of blinding and variable adherence to the protocol. Clinical and methodological heterogeneity across studies, for both the observational studies and the controlled trials, precluded any meaningful meta-analyses. Conclusions: We identified a large number of studies related to advanced airway management in adult cardiac arrest. Three recently published, large randomized trials in out-of-hospital cardiac arrest will help to inform future guidelines. Trials of advanced airway management during in-hospital cardiac arrest are lacking.

AB - Aim: To systematically review the literature on advanced airway management during adult cardiac arrest in order to inform the International Liaison Committee of Resuscitation (ILCOR) consensus on science and treatment recommendations. Methods: The review was performed according to PRISMA guidelines and registered on PROSPERO (CRD42018115556). We searched Medline, Embase, and Evidence-Based Medicine Reviews for controlled trials and observational studies published before October 30, 2018. The population included adult patients with cardiac arrest. Two investigators reviewed studies for relevance, extracted data, and assessed the risk of bias of individual studies. Results: We included 78 observational studies and 11 controlled trials. Most of the observational studies and all of the controlled trials only included patients with out-of-hospital cardiac arrest. The risk of bias for individual observational studies was overall assessed as critical or serious, with confounding and selection bias being the primary sources of bias. Three of the controlled trials, all published in 2018, were powered for clinical outcomes with two comparing a supraglottic airway to tracheal intubation and one comparing bag-mask ventilation to tracheal intubation. All three trials had some concerns regarding risk of bias primarily due to lack of blinding and variable adherence to the protocol. Clinical and methodological heterogeneity across studies, for both the observational studies and the controlled trials, precluded any meaningful meta-analyses. Conclusions: We identified a large number of studies related to advanced airway management in adult cardiac arrest. Three recently published, large randomized trials in out-of-hospital cardiac arrest will help to inform future guidelines. Trials of advanced airway management during in-hospital cardiac arrest are lacking.

KW - Airway

KW - Bag-mask

KW - Cardiac arrest

KW - ILCOR

KW - Intubation

KW - Supraglottic

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U2 - 10.1016/j.resuscitation.2019.04.003

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SN - 0300-9572

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Granfeldt A, Avis SR, Nicholson TC, Holmberg MJ, Moskowitz A, Coker A et al. Advanced airway management during adult cardiac arrest: a systematic review. Resuscitation. 2019 Jun 1;139:133-143. https://doi.org/10.1016/j.resuscitation.2019.04.003