Written by Clay Smith
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There may be a slight advantage for pediatric cardiac arrest patients in survival with good neurological outcome by using simple bag-valve mask (BVM) ventilation over advanced airway management (AAM).
Why does this matter?
AAM consists of endotracheal intubation (ETI) or supraglottic airway (SGA) placement. We covered a recent study that found an apparent advantage to just using BVM. So, should we try to place an advanced airway when a child arrests?
…or just bag them?
Evidence for AAM or simple BVM in pediatric patients with arrest is low quality. The best evidence we have is from 14 studies, with mixed in-hospital and mostly out-of-hospital cardiac arrest, that are largely retrospective in nature. In these, BVM may offer a slight advantage in survival with favorable neurological outcome over AAM. Pooling all studies, the risk difference was 0.00% (95%CI -0.06 to 0.06), which is underwhelming. When the three propensity matched cohort studies were combined, the risk difference was -0.05 (-0.08 to -0.02) favoring BVM over ETI. A big problem with all three of these studies was that it was unclear if ETI did not occur because of a failed attempt or was simply not attempted. The bottom line is that in some of the largest studies to date, all of which were lower quality evidence, AAM does not appear superior to BMV. In fact, some evidence suggests simply bagging pediatric arrest patients may be better.
Source
Advanced airway interventions for paediatric cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2019 Mar 9. pii: S0300-9572(19)30055-3. doi: 10.1016/j.resuscitation.2019.02.040. [Epub ahead of print]
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This was asked and answered by M Gauche. The alternating day approach to randomization gives the best chance for operational success with a complex intervention such as intubation.
https://jamanetwork.com/journals/jama/article-abstract/192366
No doubt, this is a key study. You’re probably right that this is one of the most definitive out there on this issue. This metaanalysis included the Gausche study. It seems clear that endotracheal intubation is at least not superior to plain bag-valve mask ventilation for pediatric arrest – and it’s probably worse.