Endotracheal Intubation Versus Supraglottic Airway for Airway Management in Adults with Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis

Abstract

Aim: The goal of this meta-analysis is to evaluate and compare the effectiveness of endotracheal intubation (ETI) and supraglottic airway (SGA) devices in airway management during out-of-hospital cardiac arrest events. Materials and Methods: Study was designed as a systematic review and meta-analysis and was conducted according to the 2020 PRISMA guidelines. Relevant studies published up to January 2024 were searched systematically using the following databases: PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library. Pooled effect sizes were calculated using a random-effects model and reported as the odds ratios and 95% confidence intervals. Results: Out of 4218 records initially identified, 25 eligible studies were selected for inclusion in a meta-analysis. Survival to hospital admission was 26.8% for ETI and 14.5% for SGA (p<0.001). Survival rates among patients treated with ETI vs. SGA varied and amounted to: 25.5% vs. 17.6% for 24-h survival rate (p<0.001); 13.4% vs. 15.1% (p=0.002); and 8.6% vs. 6.0% for survival to hospital discharge/30-d survival (p=0.09). Survival with favorable neurological outcomes occurs in 5.3% in ETI group, compared to 3.8% in SGA group (p=0.35). Conclusion: Our analysis reveals the nuanced and context-dependent nature of airway management in prehospital emergency care. The high heterogeneity across studies suggests that factors such as provider experience, patient characteristics, and the specific emergency context significantly influence outcomes.

Keywords

• endotracheal intubation
• supraglottic airway device
• airway management
• out-of-hospital cardiac arrest
• survival rate