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

Lai Peng Tham; Stephanie Fook-Chong; Nur Shahidah Binte Ahmad; Andrew Fu-Wah Ho; Hideharu Tanaka; Sang Do Shin; Patrick Chow-In Ko; Kwanhathai Darin Wong; Supasaowapak Jirapong; G V Ramana Rao; Wenwei Cai; Saad Al Qahtani; Marcus Eng Hock Ong; Pan-Asian Resuscitation Outcomes Study Clinical Research Network

doi:10.1016/j.resuscitation.2022.04.018

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

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

Authors

Affiliations

¹ Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore. Electronic address: tham.lai.peng@singhealth.com.sg.
² Prehospital Emergency & Research Centre, Duke-NUS Medical School, Singapore, Singapore.
³ Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
⁴ Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
⁵ Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan.
⁶ Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
⁷ Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁸ Emergency Department, Hospital Pulau Pinang, Penang, Malaysia.
⁹ Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand.
¹⁰ GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India.
¹¹ Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
¹² National Ambulance, Abu Dhabi, United Arab Emirates.
¹³ Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore.

PMID: 35483494
DOI: 10.1016/j.resuscitation.2022.04.018

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Airway Management / methods
Cardiopulmonary Resuscitation* / methods
Child
Cohort Studies
Emergency Medical Services* / methods
Hospitals
Humans
Intubation, Intratracheal / methods
Out-of-Hospital Cardiac Arrest* / therapy
Prospective Studies
Retrospective Studies