Use of supraglottic airway devices by paramedics in the management of adult pre-hospital cardiac arrest patients: A literature review

Abstract

Introduction Current best practice for paramedic airway management of pre-hospital cardiac arrest is being continually reviewed following changes to the emphasis on intubation as a primary intervention within international resuscitation guidelines. Subsequently, there is increased enthusiasm for the use of next generation supraglottic airway devices. This review aimed to identify the current evidence for the safety and effectiveness of supraglottic airways for the management of pre-hospital cardiac arrest. Methods A search of the electronic databases MEDLINE, PubMed, Science Direct and Cochrane Library was conducted. Papers were excluded if they did not examine airway management in the pre-hospital cardiac arrest setting, involved the use of sedative or paralysing agents, or involved paediatric patients, animals or cadavers. Results Of the 689 articles identified, 22 peer-reviewed articles were included for analysis. All 22 articles were from the following countries: United States of America, United States of America and Canada, Australia, Austria, Finland, Germany, Korea, Japan, The Netherlands, Norway, Taiwan and the United Kingdom. Discussion This review revealed large variances in both device effectiveness and patient outcome, particularly between geographical locations. Second-generation supraglottic airway devices demonstrated considerable improvement in effectiveness over their predecessors. Interestingly, the use of bag-valve mask ventilation reported better outcomes than any other form of advanced airway intervention. Studies also highlighted the diversity of airway management techniques and devices across global emergency medical service systems. Conclusion Despite favourable indications of the effectiveness and safety of the next generation supraglottic airway devices, the paucity of pre-hospital specific research (particularly randomised controlled trials) challenges decision-making regarding pre-hospital airway management best practice.