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Should We Use Advanced Airway for Pediatric Arrest?

October 16, 2019

Written by Clay Smith

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In pediatric patients with out-of-hospital cardiac arrest (OHCA), there was no survival advantage at 1-month for patients with advanced airway management (AAM) vs none.

Why does this matter?
A large in-hospital arrest registry study published in JAMA 2016 found improved survival to discharge with bag-mask ventilation vs AAM. A subsequent meta-analysis in 2019 with mixed in-hospital and OHCA pediatric arrest patients found essentially the same thing. You’ll never guess what this study found.

Should we use these?
This was an analysis of a Japanese Utstein arrest registry. They looked at 3,801 patients with pediatric OHCA. Of these, 481 (12.7%) had AAM; the rest did not. They made a matched cohort of those with AAM and those without using “risk-set matching.” In other words, they took 456 patients that had AAM and tried very hard to match them for other risk variables with those who did not receive AAM. It was a form of propensity matching to manually control for potential confounding variables, with the only difference being the one of interest – namely AAM. In the matched cohorts, they did not find a difference in 1-month survival with AAM vs not, 11.4% vs. 9.6%, respectively (risk ratio 1.15, 95%CI 0.76-1.73). As a secondary outcome, favorable neurological outcome at 1-month (CPC score 1 or 2) was also not better with AAM vs not: 2% vs 2.2%, respectively (RR 0.69, 95%CI 0.26-1.79). There was no difference in survival in any subgroup. In adults with OHCA, PART showed a supraglottic airway was better than an endotracheal tube. The same may not be true in children; 87% (418/481) with AAM had a SGA. Exploratory analyses of SGA vs no AAM also showed no difference in survival. It appears the focus during pediatric arrest should be on high quality chest compressions and bag-mask ventilation. AAM may be done later.

Prehospital advanced airway management for paediatric patients with out-of-hospital cardiac arrest: A nationwide cohort study. Resuscitation. 2019 Sep 17. pii: S0300-9572(19)30614-8. doi: 10.1016/j.resuscitation.2019.09.007. [Epub ahead of print]

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Reviewed by Thomas Davis

What are your thoughts?