title: Does pre-hospital endotracheal intubation improve survival in adults with non-traumatic out-of-hospital cardiac arrest? A systematic review.
abstract: BACKGROUND
  Endotracheal intubation (ETI) is currently considered superior to supraglottic airway devices (SGA) for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA). We aimed to determine if the research supports this conclusion by conducting a systematic review.
  
  
  METHODS
  We searched the MEDLINE, Scopus and CINAHL databases for studies published between January 1, 1980, and 30 April 30, 2013, which compared pre-hospital use of ETI with SGA for outcomes of return of spontaneous circulation (ROSC); survival to hospital admission; survival to hospital discharge; and favorable neurological or functional status. We selected studies using pre-specified criteria. Included studies were independently screened for quality using the Newcastle-Ottawa scale. We did not pool results because of study variability. Study outcomes were extracted and results presented as summed odds ratios with 95% CI.
  
  
  RESULTS
  We identified five eligible studies: one quasi-randomized controlled trial and four cohort studies, involving 303,348 patients in total. Only three of the five studies reported a higher proportion of ROSC with ETI versus SGA with no difference reported in the remaining two. None found significant differences between ETI and SGA for survival to hospital admission or discharge. One study reported better functional status at discharge for ETI versus SGA. Two studies reported no significant difference for favorable neurological status between ETI and SGA.
  
  
  CONCLUSIONS
  Current evidence does not conclusively support the superiority of ETI over SGA for multiple outcomes among adults with OHCA.
authors.affiliation: Changi General Hospital, Accident and Emergency Department, Singapore.
authors.forename: Ling
authors.initials: L
authors.lastname: Tiah
authors.affiliation: Ministry of Health, Labour and Welfare, Government of Japan, Department of Acute Medicine & Critical Care Medical Center, Osaka National Hospital, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kajino
authors.affiliation: Dubai Corporate for Ambulance Services, Dubai, United Arab Emirates.
authors.forename: Omer
authors.initials: O
authors.lastname: Alsakaf
authors.affiliation: Duke-NUS Graduate Medical School, Center for Quantitative Medicine, Singapore.
authors.forename: Dianne Carrol Tan
authors.initials: DC
authors.lastname: Bautista
authors.affiliation: Duke-NUS Graduate Medical School, Health Services and Systems Research, Singapore ; Singapore General Hospital, Department of Emergency Medicine, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.affiliation: Duke-NUS Graduate Medical School, Office of Clinical Sciences, Singapore.
authors.forename: Desiree
authors.initials: D
authors.lastname: Lie
authors.affiliation: Rashid Hospital, Department of Health & Medical Services, ED-Trauma centre, Dubai, United Arab Emirates.
authors.forename: Ghulam Yasin
authors.initials: GY
authors.lastname: Naroo
authors.affiliation: Singapore General Hospital, Department of Emergency Medicine, Singapore.
authors.forename: Nausheen Edwin
authors.initials: NE
authors.lastname: Doctor
authors.affiliation: Emergency Department, Tan Tock Seng Hospital, Singapore.
authors.forename: Michael Y C
authors.initials: MY
authors.lastname: Chia
authors.affiliation: Changi General Hospital, Accident and Emergency Department, Singapore.
authors.forename: Han Nee
authors.initials: HN
authors.lastname: Gan
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D004632:Emergency Medical Services / Q000379:methods*; D005931:Glottis; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome