Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis
Background: Airway management is vital in paediatric resuscitation, especially since respiratory conditions are frequently the primary cause of paediatric cardiac arrest. Placement of an advanced airway device may facilitate more effective resuscitation than bag-mask ventilation but requires more sk...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-05-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520425001006 |
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| author | Jason Acworth Jimena del Castillo Elliott Acworth Lokesh Tiwari Jesus Lopez-Herce Eric Lavonas Laurie Morrison Barnaby R. Scholefield |
| author_facet | Jason Acworth Jimena del Castillo Elliott Acworth Lokesh Tiwari Jesus Lopez-Herce Eric Lavonas Laurie Morrison Barnaby R. Scholefield |
| author_sort | Jason Acworth |
| collection | DOAJ |
| description | Background: Airway management is vital in paediatric resuscitation, especially since respiratory conditions are frequently the primary cause of paediatric cardiac arrest. Placement of an advanced airway device may facilitate more effective resuscitation than bag-mask ventilation but requires more skilled personnel and the time taken to perform the procedure may interfere with other vital components of resuscitation. Objectives: To assess the use of advanced airway interventions, tracheal intubation (TI) or supraglottic airway (SGA) placement, compared with bag mask ventilation (BMV) alone for resuscitation of children in cardiac arrest. Data sources: This was an update to a previous systematic review performed by ILCOR. A search of PubMed, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) was conducted for suitable studies published before 1 January 2025. This systematic review was registered as PROSPERO CRD42023482459. Study eligibility: Randomised controlled trials and non-randomised comparison studies involving airway interventions (BMV, TI, SGA) in infants and children (excluding newborn infants) in cardiac arrest in any setting were included. Study appraisal & synthesis: Investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the RoB 2 and CLARITY frameworks. Critically important outcomes included survival to hospital discharge and survival with good neurological outcome. Results: We identified 20 suitable studies (13 from the original systematic review and 7 from the updated search), including 1 pseudorandomised clinical trial, 6 observational cohort studies using propensity matching, and 9 simple cohort studies suitable for meta-analysis. The majority of studies involved out-of-hospital cardiac arrest, with few studies exploring in-hospital cardiac arrest. The overall certainty of evidence was low to very low. For the critically important outcomes of survival to hospital discharge with good neurologic outcome and survival to hospital discharge, results showed no benefit from advanced airway interventions (TI or SGA) over BMV. Conclusions: There is currently no supporting evidence that an advanced airway (supraglottic airway or tracheal intubation) during CPR improves survival or survival with a good neurological outcome after paediatric cardiac arrest in any setting when compared with bag-mask ventilation.Well-designed randomised trials are needed to address this important question. |
| format | Article |
| id | doaj-art-9c03e74bfa0346babbb020c7391ec0b6 |
| institution | Kabale University |
| issn | 2666-5204 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj-art-9c03e74bfa0346babbb020c7391ec0b62025-08-20T03:53:56ZengElsevierResuscitation Plus2666-52042025-05-012310096310.1016/j.resplu.2025.100963Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysisJason Acworth0Jimena del Castillo1Elliott Acworth2Lokesh Tiwari3Jesus Lopez-Herce4Eric Lavonas5Laurie Morrison6Barnaby R. Scholefield7Emergency Department, Queensland Children’s Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Australia; Corresponding author at: Faculty of Medicine, University of Queensland, Medical Lead, Rapid Response System, Queensland Children’s Hospital, 501 Stanley St, South Brisbane QLD 4101, Australia.Paediatric Intensive Care Department, Hospital General Universitario Gregorio Maranon de Madrid, SpainIntensive Care Unit, Gold Coast University Hospital, Southport, AustraliaDivision of Pediatric Pulmonology and Intensive Care, Department of Paediatrics, All India Institute of Medical Sciences, Rishikesh, IndiaPaediatric Intensive Care Department, Hospital General Universitario Gregorio Maranon de Madrid, SpainDepartment of Emergency Medicine, Denver Health and Hospital Authority, Denver, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USADivision of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, CanadaDepartment of Paediatric Critical Care, Hospital for Sick Children, Toronto and University of Toronto, CanadaBackground: Airway management is vital in paediatric resuscitation, especially since respiratory conditions are frequently the primary cause of paediatric cardiac arrest. Placement of an advanced airway device may facilitate more effective resuscitation than bag-mask ventilation but requires more skilled personnel and the time taken to perform the procedure may interfere with other vital components of resuscitation. Objectives: To assess the use of advanced airway interventions, tracheal intubation (TI) or supraglottic airway (SGA) placement, compared with bag mask ventilation (BMV) alone for resuscitation of children in cardiac arrest. Data sources: This was an update to a previous systematic review performed by ILCOR. A search of PubMed, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) was conducted for suitable studies published before 1 January 2025. This systematic review was registered as PROSPERO CRD42023482459. Study eligibility: Randomised controlled trials and non-randomised comparison studies involving airway interventions (BMV, TI, SGA) in infants and children (excluding newborn infants) in cardiac arrest in any setting were included. Study appraisal & synthesis: Investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the RoB 2 and CLARITY frameworks. Critically important outcomes included survival to hospital discharge and survival with good neurological outcome. Results: We identified 20 suitable studies (13 from the original systematic review and 7 from the updated search), including 1 pseudorandomised clinical trial, 6 observational cohort studies using propensity matching, and 9 simple cohort studies suitable for meta-analysis. The majority of studies involved out-of-hospital cardiac arrest, with few studies exploring in-hospital cardiac arrest. The overall certainty of evidence was low to very low. For the critically important outcomes of survival to hospital discharge with good neurologic outcome and survival to hospital discharge, results showed no benefit from advanced airway interventions (TI or SGA) over BMV. Conclusions: There is currently no supporting evidence that an advanced airway (supraglottic airway or tracheal intubation) during CPR improves survival or survival with a good neurological outcome after paediatric cardiac arrest in any setting when compared with bag-mask ventilation.Well-designed randomised trials are needed to address this important question.http://www.sciencedirect.com/science/article/pii/S2666520425001006PaediatricCardiac arrestAirwayIntubationVentilationSupraglottic |
| spellingShingle | Jason Acworth Jimena del Castillo Elliott Acworth Lokesh Tiwari Jesus Lopez-Herce Eric Lavonas Laurie Morrison Barnaby R. Scholefield Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis Resuscitation Plus Paediatric Cardiac arrest Airway Intubation Ventilation Supraglottic |
| title | Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis |
| title_full | Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis |
| title_fullStr | Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis |
| title_full_unstemmed | Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis |
| title_short | Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis |
| title_sort | advanced airway interventions for paediatric cardiac arrest updated systematic review and meta analysis |
| topic | Paediatric Cardiac arrest Airway Intubation Ventilation Supraglottic |
| url | http://www.sciencedirect.com/science/article/pii/S2666520425001006 |
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