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Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis

  • Leigh White
    Correspondence
    Corresponding author at: School of Medicine, University of Queensland, A: 12 Macon St, Birtinya, QLD 4575, Australia.
    Affiliations
    School of Medicine, University of Queensland, Brisbane, QLD, Australia

    Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
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  • Thomas Melhuish
    Affiliations
    Intensive Care Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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  • Rhys Holyoak
    Affiliations
    Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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  • Thomas Ryan
    Affiliations
    Department of Orthopaedics, John Hunter Hospital, Newcastle, NSW, Australia

    Sydney Clinical School, University of Notre Dame, Sydney, NSW, Australia
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  • Hannah Kempton
    Affiliations
    Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

    Department of Medicine, St Vincent's Hospital, Sydney, NSW, Australia
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  • Ruan Vlok
    Affiliations
    Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

    Sydney Clinical School, University of Notre Dame, Sydney, NSW, Australia

    Wagga Wagga Rural Referral Hospital, Wagga Wagga, NSW, Australia
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Published:September 26, 2018DOI:https://doi.org/10.1016/j.ajem.2018.09.045

      Abstract

      Objectives

      To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during out-of-hospital cardiac arrest (OHCA).

      Methods

      A systematic search of five databases was performed by two independent reviewers until September 2018. Included studies reported on (1) OHCA or cardiopulmonary resuscitation, and (2) endotracheal intubation versus supraglottic airway device intubation. Exclusion criteria (1) stimulation studies, (2) selectively included/excluded patients, (3) in-hospital cardiac arrest. Odds Ratios (OR) with random effect modelling was used. Primary outcomes: (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, (4) discharge with a neurologically intact state.

      Results

      Twenty-nine studies (n = 539,146) showed that overall, ETT use resulted in a heterogeneous, but significant increase in ROSC (OR = 1.44; 95%CI = 1.27 to 1.63; I2 = 91%; p < 0.00001) and survival to admission (OR = 1.36; 95%CI = 1.12 to 1.66; I2 = 91%; p = 0.002). There was no significant difference in survival to discharge or neurological outcome (p > 0.0125). On sensitivity analysis of RCTs, there was no significant difference in ROSC, survival to admission, survival to discharge or neurological outcome (p > 0.0125). On analysis of automated chest compression, without heterogeneity, ETT provided a significant increase in ROSC (OR = 1.55; 95%CI = 1.20 to 2.00; I2 = 0%; p = 0.0009) and survival to admission (OR = 2.16; 95%CI = 1.54 to 3.02; I2 = 0%; p < 0.00001).

      Conclusions

      The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in survival or neurological outcome. In the presence of automated chest compressions, ETT intubation may result in survival benefits.

      Keywords

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      References

      1. Graham R. McCoy M.A. Schultz A.M. Strategies to improve cardiac arrest survival: a time to act. National Academies Press, Washington (DC)2015
        • Callaway C.W.
        • Soar J.
        • Aibiki M.
        • et al.
        • Advanced Life Support Chapter Collaborators
        Part 4: advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.
        Circulation. 2015; 132: S84-S145
        • Wang H.E.
        • Simeone S.J.
        • Weaver M.D.
        • et al.
        Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation.
        Ann Emerg Med. 2009; 54 ([2]): 645-652.e1
        • Wang H.E.
        • Lave J.R.
        • Sirio C.A.
        • et al.
        Paramedic intubation errors: isolated events or symptoms of larger problems?.
        Health Aff. 2006; 25: 501-509
        • Benoit J.L.
        • Gerecht R.B.
        • Steuerwald M.T.
        • McMullan J.T.
        Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: a meta-analysis.
        Resuscitation. 2015; 93: 20-26
        • Fukuda T.
        • Ohashi-Fukuda N.
        • Kondo Y.
        • Hayashida K.
        • Sekiguchi H.
        • Kukita I.
        Endotracheal intubation versus supraglottic airway insertion after out-of-hospital cardiac arrest: a nationwide population-based cohort study.
        in: D94. Critical care: translating practice to outcomes for our patients with acute critical illness. American Thoracic Society, 2018: A7378
        • Bernhard M.
        • Behrens N.H.
        • Wnent J.
        • Seewald S.
        • Brenner S.
        • Jantzen T.
        • et al.
        Out-of-hospital airway management during manual compression or automated chest compression devices.
        Anaesthesist. 2018; : 1-9
        • Jabre P.
        • Penaloza A.
        • Pinero D.
        • Duchateau F.X.
        • Borron S.W.
        • Javaudin F.
        • et al.
        Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest: a randomized clinical trial.
        JAMA. 2018; 319: 779-787
        • Higgins J.P.
        • Altman D.G.
        • Gotzsche P.C.
        • Juni P.
        • Moher D.
        • Oxman A.D.
        • et al.
        The cochrane collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928https://doi.org/10.1136/bmj.d5928
        • Sterne J.A.
        • Hernán M.A.
        • Reeves B.C.
        • Savović J.
        • Berkman N.D.
        • Viswanathan M.
        • et al.
        ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.
        BMJ. 2016; 355: i4919
        • Puhan M.A.
        • Schünemann H.J.
        • Murad M.H.
        • Li T.
        • Brignardello-Petersen R.
        • Singh J.A.
        • et al.
        A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis.
        BMJ. 2014; 349: g5630
        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • Olkin I.
        • Williamson G.D.
        • Rennie D.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting.
        JAMA. 2000; 283: 2008-2012
        • Abo B.N.
        • Hostler D.
        • Wang H.E.
        Does the type of out-of-hospital airway interfere with other cardiopulmonary resuscitation tasks?.
        Resuscitation. 2007; 72: 234-239
        • Benger J.
        • Coates D.
        • Davies S.
        • Greenwood R.
        • Nolan J.
        • Rhys M.
        • et al.
        Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: a feasibility study.
        Br J Anaesth. 2016; 116: 262-268
        • Deakin C.D.
        • Clarke T.
        • Nolan J.
        • Zideman D.A.
        • Gwinnutt C.
        • Moore F.
        • et al.
        A critical reassessment of ambulance service airway management in prehospital care: Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, June 2008.
        Emerg Med J. 2010; 27: 226-233
        • Edwards T.
        • Williams J.
        • Cottee M.
        Influence of prehospital airway management on neurological outcome in patients transferred to a heart attack centre following out-of-hospital cardiac arrest.
        Emerg Med Australas. 2018;
        • Fukuda T.
        • Fukuda-Ohashi N.
        • Doi K.
        • Matsubara T.
        • Yahagi N.
        Effective pre-hospital care for out-of-hospital cardiac arrest caused by respiratory disease.
        Heart Lung Circ. 2015; 24: 241-249
        • Fullerton J.N.
        • Roberts K.J.
        • Wyse M.
        Can experienced paramedics perform tracheal intubation at cardiac arrests? Five years experience of a regional air ambulance service in the UK.
        Resuscitation. 2009; 80: 1342-1345
        • Gahan K.
        • Studnek J.R.
        • Vandeventer S.
        King LT-D use by urban basic life support first responders as the primary airway device for out-of-hospital cardiac arrest.
        Resuscitation. 2011; 82: 1525-1528
        • Guyette F.X.
        • Wang H.
        • Cole J.S.
        King airway use by air medical providers.
        Prehosp Emerg Care. 2007; 11: 473-476
        • Hagihara A.
        • Onozuka D.
        • Nagata T.
        • Hasegawa M.
        Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated.
        Am J Emerg Med. 2018; 36: 73-78
        • Hansen M.
        • Lambert W.
        • Guise J.M.
        • Warden C.R.
        • Mann N.C.
        • Wang H.
        Out-of-hospital pediatric airway management in the United States.
        Resuscitation. 2015; 90: 104-110
        • Hillis M.
        • Sinclair D.
        • Butler G.
        • Cain E.
        Prehospital cardiac arrest survival and neurologic recovery.
        J Emerg Med. 1993; 11: 245-252
        • Hilton M.T.
        • Wayne M.
        • Martin-Gill C.
        Impact of system-wide king LT airway implementation on orotracheal intubation.
        Prehosp Emerg Care. 2016; 20: 570-577
        • Hiltunen P.
        • Jäntti H.
        • Silfvast T.
        • Kuisma M.
        • Kurola J.
        Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes.
        Scand J Trauma Resusc Emerg Med. 2016; 24: 49
        • Kempema J.
        • Ali S.
        • Cabanas J.G.
        • Hinchey P.R.
        • Brown L.H.
        • Brown C.V.
        Prehospital endotracheal intubation vs extraglottic airway device in blunt trauma.
        Am J Emerg Med. 2015; 33: 1080-1083
        • Kim Y.T.
        • Do Shin S.
        • Hong S.O.
        • Ahn K.O.
        • Ro Y.S.
        • Song K.J.
        • et al.
        Effect of national implementation of utstein recommendation from the global resuscitation alliance on ten steps to improve outcomes from Out-of-Hospital cardiac arrest: a ten-year observational study in Korea.
        BMJ Open. 2017; 7e016925
        • Kurz M.C.
        • Prince D.K.
        • Christenson J.
        • Carlson J.
        • Stub D.
        • Cheskes S.
        • et al.
        Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest.
        Resuscitation. 2016; 98: 35-40
        • Middleton P.M.
        • Simpson P.M.
        • Thomas R.E.
        • Bendall J.C.
        Higher insertion success with the i-gel® supraglottic airway in out-of-hospital cardiac arrest: a randomised controlled trial.
        Resuscitation. 2014; 85: 893-897
        • Müller J.U.
        • Semmel T.
        • Stepan R.
        • Seyfried T.F.
        • Popov A.F.
        • Graf B.M.
        • et al.
        The use of the laryngeal tube disposable by paramedics during out-of-hospital cardiac arrest: a prospectively observational study (2008–2012).
        Emerg Med J. 2013; 30 ([emermed-2012]): 1012
        • Nagao T.
        • Kinoshita K.
        • Sakurai A.
        • Yamaguchi J.
        • Furukawa M.
        • Utagawa A.
        • et al.
        Effects of bag-mask versus advanced airway ventilation for patients undergoing prolonged cardiopulmonary resuscitation in pre-hospital setting.
        J Emerg Med. 2012; 42: 162-170
        • Naito H.
        • Yumoto T.
        • Maeyama H.
        • Tsukahara K.
        • Okazaki Y.
        • Mikane T.
        • et al.
        Two different medical direction for airway management in a single city did not affect outcome of out-of-hospital cardiac arrest patients.
        2017
        • Nakahara S.
        • Tomio J.
        • Ichikawa M.
        • Morimura N.
        • Nishida M.
        • Sakamoto T.
        Effectiveness of advanced airway management by paramedics for witnessed out-of-hospital cardiac arrest of cardiac origin.
        Resuscitation. 2010; 81: S18
        • Ohashi-Fukuda N.
        • Fukuda T.
        • Yahagi N.
        Effect of pre-hospital advanced airway management for out-of-hospital cardiac arrest caused by respiratory disease: a propensity score-matched study.
        Anaesth Intensive Care. 2017; 45
        • Ono Y.
        • Hayakawa M.
        • Maekawa K.
        • Mizugaki A.
        • Katabami K.
        • Wada T.
        • et al.
        Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients?.
        Am J Emerg Med. 2015; 33: 1360-1363
        • Pakkanen T.
        • Virkkunen I.
        • Silfvast T.
        • Randell T.
        • Huhtala H.
        • Ylli-Hankala A.
        One-year outcome after prehospital intubation.
        Acta Anaesthesiol Scand. 2015; 59: 524-530
        • Raatiniemi L.
        • Länkimäki S.
        • Martikainen M.
        Pre-hospital airway management by non-physicians in northern Finland–a cross-sectional survey.
        Acta Anaesthesiol Scand. 2013; 57: 654-659
        • Rehn M.
        • Hyldmo P.K.
        • Magnusson V.
        • Kurola J.
        • Kongstad P.
        • Rognås L.
        • et al.
        Scandinavian SSAI clinical practice guideline on pre-hospital airway management.
        Acta Anaesthesiol Scand. 2016; 60: 852-864
        • Sanghavi P.
        • Jena A.B.
        • Newhouse J.P.
        • Zaslavsky A.M.
        Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.
        JAMA Intern Med. 2015; 175: 196-204
        • Sollid S.J.
        • Bredmose P.P.
        • Nakstad A.R.
        • Sandberg M.
        A prospective survey of critical care procedures performed by physicians in helicopter emergency medical service: is clinical exposure enough to stay proficient?.
        Scand J Trauma Resusc Emerg Med. 2015; 23: 45
        • Sunde G.A.
        • Heltne J.K.
        • Lockey D.
        • Burns B.
        • Sandberg M.
        • Fredriksen K.
        • et al.
        Airway management by physician-staffed Helicopter Emergency Medical Services–a prospective, multicentre, observational study of 2,327 patients.
        Scand J Trauma Resusc Emerg Med. 2015; 23: 57
        • Takyu H.
        • Tanaka H.
        • Nakagawa T.
        Does the airway management device for out-of-hospital cardiac arrest have no effect to patient's outcome?.
        2014
        • Vezina M.C.
        • Trepanier C.A.
        • Nicole P.C.
        • Lessard M.R.
        Complications associated with the esophageal-tracheal Combitube® in the pre-hospital setting.
        Can J Anesth. 2007; 54: 124
        • Voss S.
        • Rhys M.
        • Coates D.
        • Greenwood R.
        • Nolan J.P.
        • Thomas M.
        • et al.
        How do paramedics manage the airway during out of hospital cardiac arrest?.
        Resuscitation. 2014; 85: 1662-1666
        • Wang H.E.
        • Kupas D.F.
        • Paris P.M.
        • Bates R.R.
        • Yealy D.M.
        Preliminary experience with a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation.
        Resuscitation. 2003; 58: 49-58
        • Wang H.E.
        • Mann N.C.
        • Mears G.
        • Jacobson K.
        • Yealy D.M.
        Out-of-hospital airway management in the United States.
        Resuscitation. 2011; 82: 378-385
        • Yanagawa Y.
        • Sakamoto T.
        Analysis of prehospital care for cardiac arrest in an urban setting in Japan.
        J Emerg Med. 2010; 38: 340-345
        • Zhang J.G.
        • Fu W.L.
        • Qian L.N.
        • Lu M.L.
        • Zhang M.
        Evaluation of the effect of a clinical pathway on the quality of simulated pre-hospital cardiopulmonary resuscitation: primary experience from a Chinese pre-hospital care centre.
        Hong Kong Eur J Emerg Med. 2015; 22: 14-22
        • Becker T.K.
        • Berning A.W.
        • Prabhu A.
        • Callaway C.W.
        • Guyette F.X.
        • Martin-Gill C.
        An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients receiving mechanical CPR with endotracheal or supraglottic airways.
        Resuscitation. 2018; 122: 61-64
        • Cady C.E.
        • Weaver M.D.
        • Pirrallo R.G.
        • Wang H.E.
        Effect of emergency medical technician–placed Combitubes on outcomes after out-of-hospital cardiopulmonary arrest.
        Prehosp Emerg Care. 2009; 13: 495-499
        • Chiang W.C.
        • Hsieh M.J.
        • Chu H.L.
        • Chen A.Y.
        • Wen S.Y.
        • Yang W.S.
        • et al.
        The effect of successful intubation on patient outcomes after out-of-hospital cardiac arrest in Taipei.
        Ann Emerg Med. 2018; 71: 387-396
        • Davey P.
        • Dicker B.
        Outcome comparison between endotracheal intubation and laryngeal mask airway use in out-of-hospital cardiac arrest: a New Zealand registry study.
        Heart Lung Circ. 2016; 25: S8
        • Do Shin S.
        • Ahn K.O.
        • Song K.J.
        • Park C.B.
        • Lee E.J.
        Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis.
        Resuscitation. 2012; 83: 313-319
        • Evans C.C.
        • Petersen A.
        • Meier E.N.
        • Buick J.E.
        • Schreiber M.
        • Kannas D.
        • et al.
        Prehospital traumatic cardiac arrest: management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries.
        J Trauma Acute Care Surg. 2016; 81: 285
        • Arslan Hanif M.
        • Kaji A.H.
        • Niemann J.T.
        Advanced airway management does not improve outcome of out-of-hospital cardiac arrest.
        Acad Emerg Med. 2010; 17: 926-931
        • Hasegawa K.
        • Hiraide A.
        • Chang Y.
        • Brown D.F.
        Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.
        JAMA. 2013; 309: 257-266
        • Jarman A.F.
        • Hopkins C.L.
        • Hansen J.N.
        • Brown J.R.
        • Burk C.
        • Youngquist S.T.
        Advanced airway type and its association with chest compression interruptions during out-of-hospital cardiac arrest resuscitation attempts.
        Prehosp Emerg Care. 2017; 21: 628-635
        • Kajino K.
        • Iwami T.
        • Kitamura T.
        • Daya M.
        • Ong M.E.H.
        • Nishiuchi T.
        • et al.
        Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest.
        Crit Care. 2011; 15: R236
        • Kang K.
        • Kim T.
        • Ro Y.S.
        • Kim Y.J.
        • Song K.J.
        • Do Shin S.
        Prehospital endotracheal intubation and survival after out-of-hospital cardiac arrest: results from the Korean nationwide registry.
        Am J Emerg Med. 2016; 34: 128-132
        • Lin S.C.
        • Hsu S.C.
        • Weng Y.M.
        • Kuo C.I.
        • Cheng C.W.
        Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?.
        Signa Vitae: J Intesive Care Emerg Med. 2013; 9: 1-6
        • McMullan J.
        • Gerecht R.
        • Bonomo J.
        • Robb R.
        • McNally B.
        • Donnelly J.
        • et al.
        Airway management and out-of-hospital cardiac arrest outcome in the CARES registry.
        Resuscitation. 2014; 85: 617-622
        • Mulder P.J.
        • Oetomo S.B.
        • Vloet L.
        • de Vries P.
        • Hoogerwerf N.
        Comparison in effectiveness and safety between a supraglottic airway device and endotracheal intubation in out-of-hospital cardiac arrest in the Netherlands.
        Resuscitation. 2013; 84: S17
        • Noda E.
        • Zaitsu A.
        • Hashizume M.
        • Takahashi S.
        Prognosis of patient with cardiopulmonary arrest transported to Kyushu University Hospital.
        Fukuoka Igaku Zasshi. 2007; 98: 73-81
        • Rabitsch W.
        • Schellongowski P.
        • Staudinger T.
        • Hofbauer R.
        • Dufek V.
        • Eder B.
        • et al.
        Comparison of a conventional tracheal airway with the combitube in an urban emergency medical services system run by physicians.
        Resuscitation. 2003; 57: 27-32
        • Sulzgruber P.
        • Datler P.
        • Sterz F.
        • Poppe M.
        • Lobmeyr E.
        • Keferböck M.
        • et al.
        The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: a propensity score matched analysis.
        Eur Heart J Acute Cardiovasc Care. 2017; 7 ([2048872617731894]): 423-431
        • Takei Y.
        • Enami M.
        • Yachida T.
        • Ohta K.
        • Inaba H.
        Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin.
        J Anesth. 2010; 24: 716-725
        • Tanabe S.
        • Ogawa T.
        • Akahane M.
        • Koike S.
        • Horiguchi H.
        • Yasunaga H.
        • et al.
        Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study.
        J Emerg Med. 2013; 44: 389-397
        • Wang H.E.
        • Szydlo D.
        • Stouffer J.A.
        • Lin S.
        • Carlson J.N.
        • Vaillancourt C.
        • et al.
        Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest.
        Resuscitation. 2012; 83: 1061-1066
        • Yeung J.
        • Chilwan M.
        • Field R.
        • Davies R.
        • Gao F.
        • Perkins G.D.
        The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.
        Resuscitation. 2014; 85: 898-904
        • Benger J.R.
        • Kirby K.
        • Black S.
        • Brett S.J.
        • Clout M.
        • Lazaroo M.J.
        • et al.
        Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial.
        JAMA. Aug 28 2018; 320: 779-791
        • Erath J.W.
        • Buettner S.
        • Weiler H.
        • Vamos M.
        • Von Jeinsen B.
        • Heyl S.
        • et al.
        P2733 prognostic implications of preclinical airway management with laryngeal tube (LTS-D) or endotracheal tube in out-of-hospital cardiac arrest patients.
        Eur Heart J. Aug 1 2018; ([ehy565-P2733])
        • Wang H.E.
        • Schmicker R.H.
        • Daya M.R.
        • Stephens S.W.
        • Idris A.H.
        • Carlson J.N.
        • et al.
        Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial.
        JAMA. Aug 28 2018; 320: 769-778
        • Sunde K.
        • Pytte M.
        • Jacobsen D.
        • Mangschau A.
        • Jensen L.P.
        • Smedsrud C.
        • et al.
        Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest.
        Resuscitation. Apr 1 2007; 73: 29-39
        • Ong M.E.
        • Ornato J.P.
        • Edwards D.P.
        • Dhindsa H.S.
        • Best A.M.
        • Ines C.S.
        • et al.
        Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation.
        JAMA. Jun 14 2006; 295: 2629-2637
        • Safar P.
        • Brown T.C.
        • Holtey W.H.
        • Wilder R.
        Ventilation and circulation with closed chest cardiac massage in man.
        JAMA. 1961; 176: 574-576
        • Rottenberg E.M.
        Overcoming the difficulties of bougie-assisted endotracheal intubation.
        Am J Emerg Med. Jan 2016; 34: 111-112
        • Pirotte M.
        • Pirotte A.
        • Trueger N.S.
        Two cases of digitally assisted bougie intubation: a novel technique for difficult airway management.
        Am J Emerg Med. 2015; ([pii: S0735-6757(15)00319-8])https://doi.org/10.1016/j.ajem.2015.04.052
        • Meyer L.
        • Stubbs B.
        • Fahrenbruch C.
        • Maeda C.
        • Harmon K.
        • Eisenberg M.
        • et al.
        Incidence, etiology, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults ages 0–35: a 30-year review.
        Circulation. Jan 1 2012; 126 ([CIRCULATIONAHA-111]): 1325-1327
        • Chowdhury A.
        • Fernandes B.
        • Melhuish T.M.
        • White L.D.
        Antiarrhythmics in cardiac arrest: a systematic review and meta-analysis.
        Heart Lung Circ. Aug 23 2017; 122: e115
        • Hypothermia after Cardiac Arrest Study Group
        Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
        N Engl J Med. 2002; 346: 549-556