title: Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis.
abstract: OBJECTIVE
  Overall survival from out-of-hospital cardiac arrest (OHCA) is less than 10%. After initial bag-valve mask ventilation, 80% of patients receive an advanced airway, either by endotracheal intubation (ETI) or placement of a supraglottic airway (SGA). The objective of this meta-analysis was to compare patient outcomes for these two advanced airway methods in OHCA patients treated by Emergency Medical Services (EMS).
  
  
  METHODS
  A dual-reviewer search was conducted in PubMed, Scopus, and the Cochrane Database to identify all relevant peer-reviewed articles for inclusion in the meta-analysis. Exclusion criteria were traumatic arrests, pediatric patients, physician/nurse intubators, rapid sequence intubation, video devices, and older airway devices. Outcomes were (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, and (4) neurologically intact survival to hospital discharge. Results were adjusted for covariates when available and combined using the random effects model.
  
  
  RESULTS
  From 3,454 titles, 10 observational studies fulfilled all criteria, representing 34,533 ETI patients and 41,116 SGA patients. Important covariates were similar between groups. Patients who received ETI had statistically significant higher odds of ROSC (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05-1.55), survival to hospital admission (OR 1.34, CI 1.03-1.75), and neurologically intact survival (OR 1.33, CI 1.09-1.61) compared to SGA. Survival to hospital discharge was not statistically different (OR 1.15, CI 0.97-1.37).
  
  
  CONCLUSIONS
  Patients with OHCA who receive ETI by EMS are more likely to obtain ROSC, survive to hospital admission, and survive neurologically intact when compared to SGA.
authors.affiliation: University of Cincinnati, College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way PO Box 670769, Cincinnati, OH, 45267-0769, USA. Electronic address: justin.benoit@uc.edu.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Benoit
authors.affiliation: University of Cincinnati, College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way PO Box 670769, Cincinnati, OH, 45267-0769, USA.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Gerecht
authors.affiliation: University of Cincinnati, College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way PO Box 670769, Cincinnati, OH, 45267-0769, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Steuerwald
authors.affiliation: University of Cincinnati, College of Medicine, Department of Emergency Medicine, 231 Albert Sabin Way PO Box 670769, Cincinnati, OH, 45267-0769, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: McMullan
mesh_terms: D058109:Airway Management / Q000379:methods; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D017063:Outcome Assessment, Health Care
keywords: Airway management; Emergency medical services; Endotracheal intubation; Out-of-hospital cardiac arrest; Prehospital; Supraglottic airway