Spotlight on Research

Recently, paramedic advanced airway interventions (AAI) in cardiac arrest have come under increased scrutiny, and supraglottic devices are becoming a more common choice over intubation where clinically appropriate. This meta-analysis specifically aimed to ascertain if patients who have suffered out-of-hospital cardiac arrest have better long (survival to discharge or to one month) and short (return of spontaneous circulation only or survival to hospital admission) term survival with AAI use, when compared to basic airway interventions (BAI).

Meta-analyses can be considered useful when the results of individual trials fail to show a definitive answer to a posed research question. By combining the results of multiple trials and then examining the total data for trends, previously unanswerable questions may be answered.

The literature search for the systematic review returned 799 papers and ultimately the meta-analysis incorporated 17 studies (publication dates between 1988–2013 for included papers) involving a total of 388 878 patients of 16 years and older, who suffered a cardiac arrest of non-traumatic origin treated in the out-of-hospital environment. For the purposes of the review BAI was defined as bag valve mask ventilation or mouth-to-mouth, with manual manoeuvres and/or the use of an orophayngeal and/or nasopharyngeal airway. AAI included endotracheal intubation (ETI), all supraglottic airways (SGA), double-lumen airways and trans-tracheal or transcricothyroid membrane airways.