Clinical paperEndotracheal intubation versus supraglottic procedure in paediatric out-of-hospital cardiac arrest: a registry-based study
Section snippets
Background
Out-of-hospital cardiac arrest (OHCA) in children remains a rare event representing around 8 events versus 62.3 events per 100,000 people in the adult population.1., 2., 3., 4. Despite medical progress in post-cardiac arrest care, paediatric OHCA still carries a low likelihood of survival.5 Evidence on practices in the management of paediatric cardiac arrest remains weak and guidelines are partly based on extrapolations from adult data.6., 7. Aetiologies of OHCA differ strongly between adults
Study design
We performed a retrospective, observational, multicentre cohort study analysis using the data from the French National OHCA Registry (RéAC) collected from July 2011 to July 2018. This cohort includes all OHCA patients managed by a physician-staffed mobile intensive care unit (MICU) in France. MICUs consist of an ambulance driver, a nurse and a trained emergency physician experienced in airway management and tracheal intubation as a minimum team. A detailed description of the French emergency
Characteristics of the patient population
Overall, we included 1641 children under 18 years of age with OHCA (Fig. 1). Sixty-two patients were excluded from the analysis because of missing data about airway management procedure by MICU (n = 58) or vital status on day 30 (n = 4, all receiving ETI).
The final population consisted of 1579 children with a median age of 3 years (0–13) (Table 1). Cardiac arrests mostly occurred in boys (62.0%, 979 of 1579), at their home/residence (58.7%, 927 of 1579) and were witnessed by a bystander (62.6%,
Discussion
In our work, we assessed the impact of airway management strategies during CPR on 30-day survival in paediatric OHCA by comparing ETI to supraglottic procedures in a large prospective cohort. The main findings were that 30-day survival and neurological outcomes were worse in the ETI group.
Airway management during CPR in children remains a thorny issue and the optimal strategy is still unclear. Current guidelines recommend BVM ventilation as the first-line method for managing the airways during
Limitations
This was an observational study using a registry, although we performed IPTW survival analysis and adjusted for selection bias to balance the groups and control for confounding factors. However, under these conditions, some authors consider the measured effect to be comparable to randomised trials.35 As airway management strategy was not randomly assigned to children, we can assume that some confounding factors that may have affected assignment to SGA or ETI or the outcomes were not controlled
Conclusions
The findings of this nationwide population-based study of paediatric OHCA suggest that ETI was associated with a worse outcome regardless of its traumatic or non-traumatic aetiology compared to supraglottic procedure. These results are in agreement with previous registry-based studies, which found an association between ETI and lower survival rates in the paediatric population. Even with a high rate of successful intubation by a trained emergency physician in our study, the ETI procedure during
Members of the GR-RéAC
Jacob Line, Ricard-Hibon Agnes, Dall acqua David, Watrelot Olivier, Narcisse Sophie, Sadoune Sonia, Guillaumee Frederic, Courcoux Hubert, Dhers marion, Gonzalez Geraldine, Capel Olivier, Ta Trung hung, Megy-Michoux Isabelle, Masson Caroline, Pernot Thomas, Poher Fabien, Joly Marc, Bages-Limoges Florence, Tentillier Eric, Blottiaux Emmanuel, Bohler Clio, Thibaut Klein, Coletta Mauro, Agostinucci Jean marc, Goument Melanie, Le pimpec Philippe, Letarnec Jean yves, Robart Jean-Christophe, Branche
Ethics and patient consent
The present study was approved by the French Advisory Committee on Information Processing in Health Research and the French National Data Protection Commission (authorisation no. 910946). It was approved as a medical assessment registry study without a requirement for patient consent.
Availability of data and materials
The datasets used and/or analysed in the current study are available from the corresponding author on reasonable request.
Conflicts of interests
The authors declare that they have no competing interests.
Funding
The RéAC registry is supported by the French Society of Emergency Medicine (SFMU), a patient foundation—Fédération Française de Cardiologie, the Mutuelle Générale de l’Education Nationale (MGEN), the University of Lille, and the Institute of Health Engineering of Lille. The authors declare that the funding sources had no role in the conduct, analysis, interpretation, or writing of this manuscript.
Authors’ contributions
QLB and FJ conceptualised the study, conducted the analysis, drafted the initial manuscript, and reviewed and revised the manuscript; JR conceptualised the study, conducted the initial analysis and drafted the initial manuscript; EM conceptualised the study and reviewed and revised the manuscript; VB collected data and reviewed and revised the manuscript; MR reviewed and revised the manuscript; HH collected data and reviewed and revised the manuscript; SL reviewed and revised the manuscript.
Acknowledgements
We thank all of the prehospital emergency medical service units involved in the French National Out-of-Hospital Cardiac Arrest Registry (RéAC).
References (35)
- et al.
Epidemiology of out-of-hospital cardiac arrest: A French national incidence and mid-term survival rate study
Anaesth Crit Care Pain Med
(2019) - et al.
Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America
Resuscitation
(2016) - et al.
Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies
Resuscitation
(2010) - et al.
Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge
Ann Emerg Med
(2005) - et al.
European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support
Resuscitation
(2015) - et al.
Advanced airway interventions for paediatric cardiac arrest: A systematic review and meta-analysis
Resuscitation
(2019) - et al.
A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database
Resuscitation
(2017) - et al.
Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest
Resuscitation
(2017) - et al.
Tracheal intubation during pediatric cardiopulmonary resuscitation: A videography-based assessment in an emergency department resuscitation room
Resuscitation
(2016) - et al.
Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study
The Lancet
(2010)