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. 2022 Jul:176:9-18.
doi: 10.1016/j.resuscitation.2022.04.018. Epub 2022 Apr 26.

Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests

Lai Peng Tham  1 , Stephanie Fook-Chong  2 , Nur Shahidah Binte Ahmad  3 , Andrew Fu-Wah Ho  4 , Hideharu Tanaka  5 , Sang Do Shin  6 , Patrick Chow-In Ko  7 , Kwanhathai Darin Wong  8 , Supasaowapak Jirapong  9 , G V Ramana Rao  10 , Wenwei Cai  11 , Saad Al Qahtani  12 , Marcus Eng Hock Ong  13 ; Pan-Asian Resuscitation Outcomes Study Clinical Research Network
Affiliations

Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests

Lai Peng Tham et al. Resuscitation. 2022 Jul.

Abstract

Background: Paediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region.

Methods: We performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort.

Results: We included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95 %CI, 0.25-0.69), p = 0.001] and survival with favourable neurological status.

Conclusion: In children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.

Keywords: Advanced airway; Advanced airway management; Bag-valve-mask ventilation; Emergency Medical Service; Endotracheal intubation; Out-of-hospital cardiac arrests; Paediatric; Prehospital; Prehospital airway management; Supraglottic airway; Survival outcomes.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MEH Ong reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR training Centre Research Program in Norway. MEH Ong has a licensing agreement and patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient. He is also the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions at triage. All other authors have no conflict of interest to declare.

Comment in

  • Potential selection bias in the baseline.
    Li Y, Yuan J, Fu H. Li Y, et al. Resuscitation. 2022 Sep;178:126. doi: 10.1016/j.resuscitation.2022.06.009. Epub 2022 Jun 18. Resuscitation. 2022. PMID: 35728743 No abstract available.
  • Reply to: Potential selection bias in the baseline.
    Tham LP, Fook-Chong S, Binte Ahmad NS, Ong MEH. Tham LP, et al. Resuscitation. 2022 Sep;178:127-129. doi: 10.1016/j.resuscitation.2022.07.002. Epub 2022 Jul 9. Resuscitation. 2022. PMID: 35820560 No abstract available.

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