UMEM Educational Pearls

Should EMS place an advanced airway in out of hospital cardiac arrests?  Current studies suggest that advanced airway management is not superior to BVM in pediatric out of hospital cardiac arrest (OHCA).  

Pediatric OHCA carries a high mortality rate and those that do survive often have a poor neurologic outcome.  This study evaluated BVM vs supraglottic airway (SGA) placement vs endotracheal intubation (ETI) in relation to one month survival and favorable neurological outcomes.  SGA and ETI were also grouped together and categorized as advanced airway management (AAM).

This study was conducted using the Pan Asian Resuscitation Outcomes Study Clinical Research Network.  3131 pediatric patients were included.  85% received BVM, 11.8% SGA and 2.6 % ETI.  In a matched cohort, one month survival and survival with favorable neurological outcome was higher in the BVM group compared to the AAM group and in the BVM group compared to the SGA group.  There was no significant difference noted between the ETI group and BVM group.

Bottom line: In this study, AAM was associated with decreased one month survival and less favorable neurological status in pediatric OHCA.


Tham LP, Fook-Chong S, Binte Ahmad NS, Ho AF, Tanaka H, Shin SD, Ko PC, Wong KD, Jirapong S, Rao GVR, Cai W, Al Qahtani S, Ong MEH; Pan-Asian Resuscitation Outcomes Study Clinical Research Network. Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests. Resuscitation. 2022 Apr 26;176:9-18. doi: 10.1016/j.resuscitation.2022.04.018. Epub ahead of print. PMID: 35483494.