Type of advanced airway and survival after pediatric out-of-hospital cardiac arrest

There is a knowledge gap about advanced airway management (AAM) after pediatric out-of-hospital cardiac arrest (OHCA) in the prehospital setting. We assessed which AAM strategy would be associated with an increased chance of survival after pediatric OHCA. A nationwide population-based observational...

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Bibliographic Details
Published in:Resuscitation 2020-05, Vol.150, p.145-153
Main Authors: Fukuda, Tatsuma, Sekiguchi, Hiroshi, Taira, Takayuki, Hashizume, Naoki, Kitamura, Yusuke, Terada, Taizo, Ohashi-Fukuda, Naoko, Kukita, Ichiro
Format: Article
Language:English
Subjects:
Adolescent
Airway Management
Cardiopulmonary Resuscitation
Child
Children
Emergency Medical Services
Endotracheal intubation
Female
Humans
Intubation, Intratracheal
Japan - epidemiology
Male
Out-of-hospital cardiac arrest
Out-of-Hospital Cardiac Arrest - therapy
Pediatrics
Supraglottic airway device
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Summary:There is a knowledge gap about advanced airway management (AAM) after pediatric out-of-hospital cardiac arrest (OHCA) in the prehospital setting. We assessed which AAM strategy would be associated with an increased chance of survival after pediatric OHCA. A nationwide population-based observational study was conducted using the Japanese government-led registry data of OHCA. Pediatric OHCA patients (aged 1–17 years) who received prehospital AAM via endotracheal intubation (ETI) or supraglottic airway (SGA) insertion by emergency medical service (EMS) personnel from 2011 to 2017 were included. Patients who received ETI were compared with those who received SGA insertion. The primary outcome was one-month survival after OHCA. A total of 967 patients (mean [SD] age, 12.2 [5.1] years; 66.6% male) were included; 113 received ETI, and 854 received SGA insertion. Among the total cohort, 118 (12.2%) survived one month after OHCA. In the propensity score-matched cohort, no difference was observed in one-month survival between the ETI and SGA insertion groups: 13 of 113 patients (11.5%) vs 12 of 113 patients (10.6%); RR, 1.08; 95%CI, 0.52–2.27. This lack of association between AAM strategy and survival was observed across a variety of subgroup and sensitivity analyses, and also for neurologically favorable survival (P = 0.5611) in the propensity score-matched analysis. In Japan, among pediatric OHCA patients, there was no significant difference in one-month survival between prehospital ETI and SGA insertion by EMS personnel. Although an adequately powered randomized controlled trial is needed, EMS personnel may choose their familiar strategy when prehospital AAM was performed during pediatric OHCA.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2020.02.005