Outcomes of cardiopulmonary resuscitation between endotracheal intubation and supraglottic airway placement for patients with out-of-hospital cardiac arrest: a meta- analysis

Objective To evaluate the outcome of cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA) patients who received endotracheal intubation (ETI) or supraglottic airway (SGA) placement. Methods Systematic searches were conducted in Cochrane Library, PubMed, Embase, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Wanfang data to collect studies comparing ETI and SGA performed by emergency medical service system (EMSS) staff for patients with OHCA published up to September 8, 2018. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.3 software. Results Thirteen cohort studies and one randomized controlled trial with 40 063 ETI patients and 47 897 SGA patients were enrolled. Meta-analysis demonstrated that the return of spontaneous circulation [odds ratio (OR)=1.20, 95% confidence interval (CI) (1.06, 2.51), Z=2.98, P=0.003] and neurologically intact survival after hospital discharge [OR=1.09, 95%CI (1.01, 1.19), Z=2.09, P=0.04] in the ETI group were much better than those in the SGA group. However, there were no significant differences in the admission survival rate [OR=1.14, 95%CI (1.00, 1.30), Z=1.97, P=0.05] and discharge survival rate [OR=1.04, 95%CI (0.97, 1.12), Z=1.16, P=0.25] between the two groups. Conclusion ETI performed by EMSS staff for patients with OHCA is much better than SGA. Key words: Out-of-hospital cardiac arrest; Cardiopulmonary resuscitation; Intubation, intratracheal; Supraglottic airway