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

Research output: Research - peer-reviewArticle

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.

LanguageEnglish (US)
Pages51-56
Number of pages6
JournalResuscitation
Volume120
DOIs
StatePublished - Nov 1 2017

Fingerprint

Out-of-Hospital Cardiac Arrest
Airway Management
Masks
Heart Arrest
Registries
Databases
Pediatrics
Survival
Intratracheal Intubation
Emergency Medical Services
Propensity Score
Pediatric Hospitals
Resuscitation
Cohort Studies
Randomized Controlled Trials
Retrospective Studies
Odds Ratio
Equipment and Supplies

Keywords

  • Airway management
  • Emergency medical services for children
  • Out-of-hospital cardiac arrest
  • Pediatrics

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

@article{b2f239061ac24d098eb94f2299097def,
title = "A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database",
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.",
keywords = "Airway management, Emergency medical services for children, Out-of-hospital cardiac arrest, Pediatrics",
author = "Hansen, {Matthew L.} and Amber Lin and Carl Eriksson and Mohamud Daya and Bryan McNally and Rongwei Fu and David Yanez and Dana Zive and Craig Newgard",
year = "2017",
month = "11",
doi = "10.1016/j.resuscitation.2017.08.015",
volume = "120",
pages = "51--56",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database

AU - Hansen,Matthew L.

AU - Lin,Amber

AU - Eriksson,Carl

AU - Daya,Mohamud

AU - McNally,Bryan

AU - Fu,Rongwei

AU - Yanez,David

AU - Zive,Dana

AU - Newgard,Craig

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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.

AB - 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.

KW - Airway management

KW - Emergency medical services for children

KW - Out-of-hospital cardiac arrest

KW - Pediatrics

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