Early Versus Late Advanced Airway Management for Pediatric Patients With Out-of-Hospital Cardiac Arrest

• Published in: Annals of emergency medicine 2024-03, Vol.83 (3), p.185-195
• Main Authors: Amagasa, Shunsuke, Iwamoto, Shintaro, Kashiura, Masahiro, Yasuda, Hideto, Kishihara, Yuki, Uematsu, Satoko
• Format: Article
• Language: English
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2023.09.023

To determine the association between early versus late advanced airway management and improved outcomes in pediatric out-of-hospital cardiac arrest. We performed a retrospective cohort study using data from the out-of-hospital cardiac arrest registry in Japan. We included pediatric patients (20 minutes) advanced airway management. The primary and secondary outcome measurements were survival and favorable neurologic outcomes at 1 month, respectively. To address resuscitation time bias, we performed risk-set matching analyses using time-dependent propensity scores. Out of the 864 pediatric patients with both out-of-hospital cardiac arrest and advanced airway management over 67 months (2014 to 2019), we included 667 patients with adequate data (77%). Of these 667 patients, advanced airway management was early for 354 (53%) and late for 313 (47%) patients. In the risk-set matching analysis, the risk of both survival (risk ratio 0.98 for early versus late [95% confidence interval 0.95 to 1.02]) and favorable 1-month neurologic outcomes (risk ratio 0.99 [95% confidence interval 0.97 to 1.00]) was similar between early and late advanced airway management groups. In sensitivity analyses, with time to early advanced airway management defined as ≤10 minutes and ≤30 minutes, both outcomes were again similar. In pediatric out-of-hospital cardiac arrest, the timing of advanced airway management may not affect patient outcomes, but randomized controlled trials are needed to address this question further.