A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database

• Type of Material: Article
• Authors: Matthew L. Hansen, Oregon Health and Science University; Amber Lin, Oregon Health and Science University; Carl Eriksson, Oregon Health and Science University; Mohamud Daya, Oregon Health and Science University; Bryan McNally, Emory University; Rongwei Fu, Oregon Health and Science University; David Yanez, Oregon Health and Science University; Dana Zive, Oregon Health and Science University; Craig Newgard, Oregon Health and Science University
• Language: English
• Date: 2017-11-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.resuscitation.2017.08.015
• Title of Journal or Parent Work: Resuscitation
• ISSN: 0300-9572
• Volume: 120
• Start Page: 51
• End Page: 56
• Grant/Funding Information: This work is funded by the National Heart Lung and Blood Institute grant number 5K12HL108974-04
• Keywords: OUTCOMES; Critical Care Medicine; Pediatrics; REGISTRY; HYPERVENTILATION; Airway management; SURVIVAL; ASSOCIATION; Out-of-hospital cardiac arrest; Emergency Medicine; Emergency medical services for children; Science & Technology; General & Internal Medicine; INTUBATION; REGRESSION; RESUSCITATION; MULTIPLE IMPUTATION; Life Sciences & Biomedicine; EPIDEMIOLOGY
• Research Categories: Health Sciences, Public Health

Abstract

Objective To compare odds of survival to hospital discharge among pediatric out-of-hospital cardiac arrest (OHCA) patients receiving either bag-valve-mask ventilation (BVM), supraglottic airway (SGA) or endotracheal intubation (ETI), after adjusting for the propensity to receive a given airway intervention. Methods Retrospective cohort study using the Cardiac Arrest Registry to Enhance Survival (CARES) database from January 1 201–December 31, 2015. The CARES registry includes data on cardiac arrests from 17 statewide registries and approximately 55 additional US cities. We included patients less than18 years of age who suffered a non-traumatic OHCA and received a resuscitation attempt by Emergency Medical Services (EMS). The key exposure was the airway management strategy (BVM, ETI, or SGA). The primary outcome was survival to hospital discharge. Results Of the 3793 OHCA cases included from 405 EMS agencies, 1724 cases were analyzed after limiting the analysis to EMS agencies that used all 3 devices. Of the 1724, 781 (45.3%) were treated with BVM only, 727 (42.2%) ETI, and 215 (12.5%) SGA. Overall, 20.7% had ROSC and 10.9% survived to hospital discharge. After using a propensity score analysis, the odds ratio for survival to hospital discharge for ETI compared to BVM was 0.39 (95%CI 0.26–0.59) and for SGA compared to BVM was 0.32 (95% CI 0.12–0.84). These relationships were robust to the sensitivity analyses including complete case, EMS-agency matched, and age-stratified. Conclusions BVM was associated with higher survival to hospital discharge compared to ETI and SGA. A large randomized clinical trial is needed to confirm these findings.