Yang Zhanzheng, Liang Hengrui, Li Jiaying, Qiu Shuxian, He Zhuosen, Li Jinyin, Cao Zanfeng, Yan Ping, Liang Qing, Zeng Liangbo, Liu Rong, Liang Zijing
Department of Emergency Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Depertment of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health (GIRH), State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.
Ann Transl Med. 2019 Jun;7(12):257. doi: 10.21037/atm.2019.05.21.
For subjects with out-of-hospital cardiac arrest (OHCA), bag-valve mask (BVM), endotracheal intubation (ETI), and laryngeal mask airway (LMA) are the most common methods of ventilatory support; however, the best choice remains controversial.
A comprehensive search of online databases was performed. A traditional meta-analysis was performed to determine the risk ratio of BVM LMA and ETI LMA. Indirect treatment comparisons (ITCs) were conducted to compare BVM and ETI.
A total of 13 full-text articles reporting the efficacy of BVM, ETI, and LMA were considered in this analysis. BVM and LMA had the same effect regarding return of spontaneous circulation (ROSC) (23% 24%; RR =0.84), survival rate at admission (19% 21%; RR =0.82) or discharge (6% 4%; RR =0.61). ETI was superior to LMA in terms of ROSC (48% 23%; RR =0.72) and survival rate at both admission (27% 19%; RR =0.85) and discharge (12% 4%; RR =0.90). BVM was inferior to ETI in terms of ROSC (24% 48%; RR =0.86), survival to admission rate (21% 27%; RR =1.037), and survival to discharge rate (6% 12%; RR =1.476).
ETI should be considered for airway management as early as possible, which can improve the subject's success rate of recovery and survival to admission rate. In future, large-scale, multi-center, randomized controlled studies should be conducted to evaluate the exact efficacy of BVM, ETI, and LMA for the first aid of subjects with OHCA.
对于院外心脏骤停（OHCA）患者，球囊面罩通气（BVM）、气管插管（ETI）和喉罩气道通气（LMA）是最常用的通气支持方法；然而，最佳选择仍存在争议。
对在线数据库进行全面检索。采用传统荟萃分析确定BVM与LMA、ETI与LMA的风险比。进行间接治疗比较（ITC）以比较BVM和ETI。
本分析共纳入13篇报告BVM、ETI和LMA疗效的全文文章。BVM和LMA在自主循环恢复（ROSC）方面效果相同（23%对24%；RR = 0.84），入院生存率（19%对21%；RR = 0.82）或出院生存率（6%对4%；RR = 0.61）。在ROSC方面，ETI优于LMA（48%对23%；RR = 0.72），在入院和出院时的生存率方面也优于LMA（入院时：27%对19%；RR = 0.85；出院时：12%对4%；RR = 0.90）。在ROSC方面，BVM不如ETI（24%对48%；RR = 0.86），入院生存率（21%对27%；RR = 1.037）和出院生存率（6%对12%；RR = 1.476）。
应尽早考虑将ETI用于气道管理，这可以提高患者的复苏成功率和入院生存率。未来，应开展大规模、多中心、随机对照研究，以评估BVM、ETI和LMA对OHCA患者急救的确切疗效。
