Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ann Emerg Med. 2020 May;75(5):627-636. doi: 10.1016/j.annemergmed.2019.12.003. Epub 2020 Jan 23.
We compare effectiveness of different airway interventions during cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest.
We systematically searched the PubMed and EMBASE databases from their inception through August 2018 and selected randomized controlled trials or quasi randomized controlled trials comparing intubation, supraglottic airways, or bag-valve-mask ventilation for treating adult out-of-hospital cardiac arrest patients. We performed a network meta-analysis along with sensitivity analyses to investigate the influence of high intubation success rate on meta-analytic results.
A total of 8 randomized controlled trials and 3 quasi randomized controlled trials were included in the network meta-analysis: 7,361 patients received intubation, 7,475 received supraglottic airway, and 1,201 received bag-valve-mask ventilation. The network meta-analysis indicated no differences among these interventions for survival or neurologic outcomes at hospital discharge. Rather, network meta-analysis suggested that supraglottic airway improved the rate of return of spontaneous circulation compared with intubation (odds ratio 1.11; 95% confidence interval 1.03 to 1.20) or bag-valve-mask ventilation (odds ratio 1.35; 95% confidence interval 1.11 to 1.63). Furthermore, intubation improved the rate of return of spontaneous circulation compared with bag-valve-mask ventilation (odds ratio 1.21; 95% confidence interval 1.01 to 1.44). The sensitivity analyses revealed that the meta-analytic results were sensitive to the intubation success rates across different out-of-hospital care systems.
Although there were no differences in long-term survival or neurologic outcome among these airway interventions, these system-based comparisons demonstrated that supraglottic airway was better than intubation or bag-valve-mask ventilation and intubation was better than bag-valve-mask ventilation in improving return of spontaneous circulation. The intubation success rate greatly influenced the meta-analytic results, and therefore these comparison results should be interpreted with these system differences in mind.
我们比较了心肺复苏期间不同气道干预措施对院外心搏骤停患者的效果。
我们系统地检索了 PubMed 和 EMBASE 数据库，从建库到 2018 年 8 月，选择比较气管插管、声门上气道或球囊面罩通气治疗成人院外心搏骤停患者的随机对照试验或准随机对照试验。我们进行了网络荟萃分析，并进行了敏感性分析，以探讨高插管成功率对荟萃分析结果的影响。
共有 8 项随机对照试验和 3 项准随机对照试验纳入网络荟萃分析：7361 例患者接受了气管插管，7475 例患者接受了声门上气道，1201 例患者接受了球囊面罩通气。网络荟萃分析表明，这些干预措施在出院时的生存率或神经功能结局方面没有差异。相反，网络荟萃分析表明，与气管插管（比值比 1.11；95%置信区间 1.03 至 1.20）或球囊面罩通气（比值比 1.35；95%置信区间 1.11 至 1.63）相比，声门上气道可提高自主循环恢复率。此外，与球囊面罩通气相比，气管插管可提高自主循环恢复率（比值比 1.21；95%置信区间 1.01 至 1.44）。敏感性分析表明，荟萃分析结果对不同院外护理系统的插管成功率敏感。
尽管这些气道干预措施在长期生存率或神经功能结局方面没有差异，但这些基于系统的比较表明，声门上气道优于气管插管或球囊面罩通气，气管插管优于球囊面罩通气，可提高自主循环恢复率。插管成功率对荟萃分析结果影响很大，因此，应考虑这些系统差异来解释这些比较结果。
