title: Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest.
abstract: Respiratory care may be important in pediatric out-of-hospital cardiac arrest (OHCA) due to the asphyxial nature of the majority of events. However, evidence of the effect of prehospital advanced airway management (AAM) for pediatric OHCA is scarce.
  
  
  
  This was a nationwide population-based study of pediatric OHCA in Japan from 2011 to 2012 based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients aged between 1 and 17 years old. The primary outcome was one-month neurologically favorable survival defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1-2 (corresponding to a Pediatric CPC score of 1-3).
  
  
  
  A total of 2157 patients were included in the final cohort; 365 received AAM and 1792 received bag-valve-mask (BVM) ventilation only. Among the 2157 patients, 213 (9.9%) survived with favorable neurological outcomes (CPC of 1-2) one month after OHCA. There were no significant differences in neurologically favorable survival between the AAM and BVM groups after adjusting for potential confounders, although there was a tendency favoring BVM ventilation: propensity score matching, OR 0.74 (95%CI 0.35-1.59), and multivariable logistic regression modeling, ORadjusted0.55 (95%CI 0.24-1.14). Subgroup analyses demonstrated that there were no subgroups in which AAM was associated with neurologically favorable survival, including the non-cardiac (primarily asphyxial) etiology group.
  
  
  
  In pediatric OHCA, prehospital AAM was not associated with an increased chance of neurologically favorable survival compared with BVM-only ventilation. However, careful consideration is required to interpret the findings, as there may be unmeasured residual confounders and selection bias.
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Comprehensive Perinatal Medical Center, Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Ohashi-Fukuda
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: tatsumafukuda-jpn@umin.ac.jp.
authors.forename: Tatsuma
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Kent
authors.initials: K
authors.lastname: Doi
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Morimura
mesh_terms: D058109:Airway Management / Q000379:methods*; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011159:Population Surveillance; D057216:Propensity Score; D012042:Registries; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000379:methods*
keywords: Cardiopulmonary resuscitation; Children; Epidemiology; Out-of-hospital cardiac arrest; Pediatrics