Jasmeet Soar1, Jerry P Nolan. 1. Southmead Hospital, North Bristol NHS Trust, Bristol, UK. Jasmeet.soar@nbt.nhs.uk
Abstract
PURPOSE OF REVIEW: The optimal method for airway management during cardiac arrest is unknown. This review summarizes recent evidence comparing the use of basic and advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation], including the role of capnography during cardiac arrest. RECENT FINDINGS: A large observational study [649,359 out-of-hospital cardiac arrests (OHCAs)] has shown that the risk-adjusted odds of neurologically favourable survival were higher for those treated with bag-mask ventilation compared with SGA insertion or tracheal intubation. Two recent, large observational studies suggest that tracheal intubation for OHCA may be superior to SGA use. These observational studies share an important weakness: they rely on statistical risk-adjustment to account for other factors that may influence outcome, and hidden confounders may account for the differences in outcome associated with each of the airway management strategies. SUMMARY: Most of the evidence about airway management during cardiac arrest comes from observational studies. The best airway option is likely to be different for different rescuers, and at different time points of the resuscitation process. Properly designed, prospective, randomized trials are needed to help determine the optimal airway strategy. In our view, there is currently sufficient clinical equipoise to support such trials.
PURPOSE OF REVIEW: The optimal method for airway management during cardiac arrest is unknown. This review summarizes recent evidence comparing the use of basic and advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation], including the role of capnography during cardiac arrest. RECENT FINDINGS: A large observational study [649,359 out-of-hospital cardiac arrests (OHCAs)] has shown that the risk-adjusted odds of neurologically favourable survival were higher for those treated with bag-mask ventilation compared with SGA insertion or tracheal intubation. Two recent, large observational studies suggest that tracheal intubation for OHCA may be superior to SGA use. These observational studies share an important weakness: they rely on statistical risk-adjustment to account for other factors that may influence outcome, and hidden confounders may account for the differences in outcome associated with each of the airway management strategies. SUMMARY: Most of the evidence about airway management during cardiac arrest comes from observational studies. The best airway option is likely to be different for different rescuers, and at different time points of the resuscitation process. Properly designed, prospective, randomized trials are needed to help determine the optimal airway strategy. In our view, there is currently sufficient clinical equipoise to support such trials.
Authors: Jerry P Nolan; Robert A Berg; Stephen Bernard; Bentley J Bobrow; Clifton W Callaway; Tobias Cronberg; Rudolph W Koster; Peter J Kudenchuk; Graham Nichol; Gavin D Perkins; Tom D Rea; Claudio Sandroni; Jasmeet Soar; Kjetil Sunde; Alain Cariou Journal: Intensive Care Med Date: 2017-03-11 Impact factor: 17.440
Authors: Laura Goodwin; Katie Samuel; Behnaz Schofield; Sarah Voss; Stephen J Brett; Keith Couper; Doug Gould; David Harrison; Ranjit Lall; Jerry P Nolan; Gavin D Perkins; Jasmeet Soar; Matthew Thomas; Jonathan Benger Journal: J Intensive Care Soc Date: 2020-08-18
Authors: Jonathan R Benger; Kim Kirby; Sarah Black; Stephen J Brett; Madeleine Clout; Michelle J Lazaroo; Jerry P Nolan; Barnaby C Reeves; Maria Robinson; Lauren J Scott; Helena Smartt; Adrian South; Elizabeth A Stokes; Jodi Taylor; Matthew Thomas; Sarah Voss; Sarah Wordsworth; Chris A Rogers Journal: Health Technol Assess Date: 2022-04 Impact factor: 4.106
Authors: Sarah Voss; Megan Rhys; David Coates; Rosemary Greenwood; Jerry P Nolan; Matthew Thomas; Jonathan Benger Journal: Resuscitation Date: 2014-09-26 Impact factor: 5.262
Authors: Jonathan R Benger; Kim Kirby; Sarah Black; Stephen J Brett; Madeleine Clout; Michelle J Lazaroo; Jerry P Nolan; Barnaby C Reeves; Maria Robinson; Lauren J Scott; Helena Smartt; Adrian South; Elizabeth A Stokes; Jodi Taylor; Matthew Thomas; Sarah Voss; Sarah Wordsworth; Chris A Rogers Journal: JAMA Date: 2018-08-28 Impact factor: 56.272