Xiangya Nursing School of Central South University, Changsha, Hunan, China.
Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Emergency Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Am J Emerg Med. 2022 Jul;57:60-69. doi: 10.1016/j.ajem.2022.04.027. Epub 2022 Apr 27.
The optimal airway management strategy for cardiac arrest remains unclear. This study aimed to compare the effects of different initial airway interventions on improving clinical outcomes based on the 2010 cardiopulmonary resuscitation (CPR) guidelines and later.
We searched PubMed, EMBASE, and the Cochrane Library for CPR articles tailored to each database from October 19, 2010, to July 31, 2021, to compare endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BMV). The initial results and long-term results were investigated by meta-analysis.
Twenty-five articles (n = 196,486) were included. The ROSC rate in the ETI group (ES = 0.49, 95% CI: 0.38-0.59) was significantly higher than that in the SGA group (ES = 0.27, 95% CI: 0.20-0.34) and BMV group (ES = 0.24, 95% CI: 0.17-0.31). The rate of ROSC upon admission to the hospital in the ETI group (ES = 0.27, 95% CI: 0.13-0.42) was significantly higher than that in the SGA group (ES = 0.18, 95% CI: 0.13-0.23) and BMV group (ES = 0.16, 95% CI: 0.10-0.22). Compared with the BMV group (ES = 0.09, 95% CI: 0.04-0.14) and the SGA group (ES = 0.08, 95% CI: 0.05-0.10), the ETI group (ES = 0.14, 95% CI: 0.10-0.17) had a higher discharge rate, but all of the groups had the same neurological outcome (ETI group [ES = 0.06, 95% CI: 0.04-0.08], BMV group [ES = 0.05, 95% CI: 0.03-0.08] and SGA group [ES = 0.04, 95% CI: 0.03-0.05]).
Opening the airway is significantly associated with improved clinical outcomes, and the findings suggest that effective ETI based on mask ventilation should be implemented as early as possible once the patient has experienced cardiac arrest.
心脏骤停的最佳气道管理策略仍不清楚。本研究旨在根据 2010 年心肺复苏（CPR）指南和之后的研究，比较不同初始气道干预措施对改善临床结局的影响。
我们从 2010 年 10 月 19 日至 2021 年 7 月 31 日，在 PubMed、EMBASE 和 Cochrane 图书馆中搜索了针对每个数据库的 CPR 文章，以比较气管内插管（ETI）、声门上气道（SGA）或球囊-面罩通气（BMV）。通过荟萃分析研究了初始结果和长期结果。
共纳入 25 篇文章（n=196486）。ETI 组的 ROSC 率（ES=0.49，95%CI：0.38-0.59）明显高于 SGA 组（ES=0.27，95%CI：0.20-0.34）和 BMV 组（ES=0.24，95%CI：0.17-0.31）。ETI 组入院时 ROSC 率（ES=0.27，95%CI：0.13-0.42）明显高于 SGA 组（ES=0.18，95%CI：0.13-0.23）和 BMV 组（ES=0.16，95%CI：0.10-0.22）。与 BMV 组（ES=0.09，95%CI：0.04-0.14）和 SGA 组（ES=0.08，95%CI：0.05-0.10）相比，ETI 组（ES=0.14，95%CI：0.10-0.17）的出院率更高，但所有组的神经功能结局相同（ETI 组[ES=0.06，95%CI：0.04-0.08]、BMV 组[ES=0.05，95%CI：0.03-0.08]和 SGA 组[ES=0.04，95%CI：0.03-0.05]）。
开放气道与改善临床结局显著相关，结果表明，一旦患者发生心脏骤停，应尽早实施基于面罩通气的有效 ETI。
