Airway Management Training Might Improve Return Of Spontaneous Circulation Rate in Out-of-Hospital Cardiac Arrest Using Supraglottic Airways vs. Endotracheal Intubation: A Systematic Review and Meta-Analysis

BACKGROUND: The optimal airway management strategy in out-of-hospital cardiac arrest has been controversial. Whereas endotracheal intubation currently represents the gold standard, supraglottic airway securement may provide advantages with respect to handling out-of-hospital cardiac arrest. OBJECTIVES: This meta-analysis of randomized controlled and clinical studies evaluates the effects of the advanced airway strategy (supraglottic vs. endotracheal intubation) on return of spontaneous circulation (ROSC). METHODS: This systematic review and meta-analysis was performed based on a predefined protocol. Literature search included PubMed, Web of Science, and the Cochrane Library. RESULTS: A total of eight clinical studies including 14,797 patients were analyzed. Pooled analysis indicated no higher rate of ROSC in patients treated with supraglottic airway vs. endotracheal intubation (risk difference [RD] 0.02, 95% confidence interval [CI] 0.0-0.04, p = 0.11) and no higher rate of survival to hospital discharge (RD 0.01, 95% CI -0.01-0.02, p = 0.30). Interestingly, additional training indicated a significant effect of supraglottic airway on ROSC, whereas the subgroup difference was not significant (RD [additional training] 0.02, 95% CI 0.0-0.04, p = 0.02, RD [no additional training] 0.01, 95% CI -0.05-0.01, p = 0.72, test for subgroup differences, p = 0.73). Training programs differed between the investigated studies. Statistical heterogeneity was not observed. CONCLUSION: Overall, the type of advanced airway (supraglottic vs. endotracheal intubation) did not impact ROSC or survival to hospital discharge. However, after additional training, supraglottic airway use may have a positive effect on ROSC in out-of-hospital cardiac arrest.