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Resuscitation. 2019 May;138:114-128. doi: 10.1016/j.resuscitation.2019.02.040. Epub 2019 Mar 9.

Advanced airway interventions for paediatric cardiac arrest: A systematic review and meta-analysis.

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Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. Electronic address:
Departments of Emergency and Critical Care Medicine, Hiroshima University, Hiroshima, Japan. Electronic address:
New Zealand Resuscitation Council, Wellington, New Zealand. Electronic address:
Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium; EMS Dispatch Center Eastern Flanders, Federal Department of Health, Belgium. Electronic address:
Department of Paediatric Intensive Care Medicine, Starship Child Health, Central Auckland, New Zealand. Electronic address:
Department of Paediatric Emergency Medicine, St. Mary's Hospital, London, United Kingdom. Electronic address:
Scotiabank Health Sciences Library, St. Michael's Hospital, Li Ka Shing International Healthcare Education Centre, Toronto, Ontario, Canada. Electronic address:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital,Toronto, Ontario, Canada. Electronic address:



To assess the use of advanced airway interventions (tracheal intubation (TI) or supraglottic airway (SGA) placement), compared with bag mask ventilation (BMV) alone, for resuscitation of children in cardiac arrest.


We searched Medline, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) for human trials and observational studies published before September 24, 2018 for clinical trials and observational studies with a comparison group. Two investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the GRADE and CLARITY frameworks. Study authors were contacted when necessary to obtain additional data. Critically important outcomes included survival to hospital discharge and survival with good neurological outcome.


We identified 14 studies, including 1 pseudorandomised clinical trial, 3 observational cohort studies using propensity matching, and 8 simple cohort studies suitable for meta-analysis. The overall certainty of evidence was low to very low. For the critically important outcomes of survival to hospital discharge with good neurologic outcome and survival to hospital discharge results suggested better outcomes achieved with BMV than either TI or SGA; limited data favored SGA over TI. The majority of studies involved out-of-hospital cardiac arrest, with few studies of in-hospital cardiac arrest.


TI or SGA are not superior to BMV for resuscitation of children in cardiac arrest, but the overall certainty of evidence is low to very low. Well designed randomised efficacy trials are needed to address this important question.

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