https://scholars.lib.ntu.edu.tw/handle/123456789/466039
標題: | Comparing Effectiveness of Initial Airway Interventions for Out-of-Hospital Cardiac Arrest: A Systematic Review and Network Meta-analysis of Clinical Controlled Trials | 作者: | CHIH-HUNG WANG Lee A.-F. WEI-TIEN CHANG CHIEN-HUA HUANG MIN-SHAN TSAI Chou E. CHIEN-CHANG LEE SHYR-CHYR CHEN WEN-JONE CHEN |
公開日期: | 2020 | 來源出版物: | Annals of Emergency Medicine | 摘要: | Study objective: We compare effectiveness of different airway interventions during cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest. Methods: We systematically searched the PubMed and EMBASE databases from their inception through August 2018 and selected randomized controlled trials or quasi randomized controlled trials comparing intubation, supraglottic airways, or bag-valve-mask ventilation for treating adult out-of-hospital cardiac arrest patients. We performed a network meta-analysis along with sensitivity analyses to investigate the influence of high intubation success rate on meta-analytic results. Results: A total of 8 randomized controlled trials and 3 quasi randomized controlled trials were included in the network meta-analysis: 7,361 patients received intubation, 7,475 received supraglottic airway, and 1,201 received bag-valve-mask ventilation. The network meta-analysis indicated no differences among these interventions for survival or neurologic outcomes at hospital discharge. Rather, network meta-analysis suggested that supraglottic airway improved the rate of return of spontaneous circulation compared with intubation (odds ratio 1.11; 95% confidence interval 1.03 to 1.20) or bag-valve-mask ventilation (odds ratio 1.35; 95% confidence interval 1.11 to 1.63). Furthermore, intubation improved the rate of return of spontaneous circulation compared with bag-valve-mask ventilation (odds ratio 1.21; 95% confidence interval 1.01 to 1.44). The sensitivity analyses revealed that the meta-analytic results were sensitive to the intubation success rates across different out-of-hospital care systems. Conclusion: Although there were no differences in long-term survival or neurologic outcome among these airway interventions, these system-based comparisons demonstrated that supraglottic airway was better than intubation or bag-valve-mask ventilation and intubation was better than bag-valve-mask ventilation in improving return of spontaneous circulation. The intubation success rate greatly influenced the meta-analytic results, and therefore these comparison results should be interpreted with these system differences in mind. ? 2019 American College of Emergency Physicians |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/466039 | ISSN: | 0196-0644 | DOI: | 10.1016/j.annemergmed.2019.12.003 | SDG/關鍵字: | adult; clinical outcome; comparative effectiveness; Conference Paper; Embase; endotracheal intubation; hospital discharge; human; intervention study; long term survival; Medline; meta analysis; network meta-analysis; neurologic disease; out of hospital cardiac arrest; priority journal; randomized controlled trial (topic); resuscitation; return of spontaneous circulation; sensitivity analysis; systematic review; emergency health service; out of hospital cardiac arrest; procedures; respiration control; resuscitation; Airway Management; Cardiopulmonary Resuscitation; Emergency Medical Services; Humans; Intubation, Intratracheal; Network Meta-Analysis; Out-of-Hospital Cardiac Arrest; Randomized Controlled Trials as Topic |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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