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Airway Management (Non-intubation)

Date Last Search Run: Feb 01, 2022
Table last updated: Nov 30, 2022
Data last added: Nov 28, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)    
3 (weak evidence exists)      


Interventions

BVM
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Survival to hospital discharge and neurological status at discharge Patient PH-Paramedic Gausche M., Lewis R., Stratton, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA 2000; 283:783-98. Medline
I Neutral (Yellow) Error rate Process Hansen M., Eriksson C., Skarica B., Meckler G., Guise JM. Safety events in pediatric out-of-hospital cardiac arrest. Am J Emerg Med 2018; 36(3):380-383. Medline
II Supportive (Green) survival to discharge Process PH-Paramedic Hansen ML., Lin A., Eriksson C., Daya M., McNally B., Fu R., et al. A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database. Resuscitation 2017; 120 51-6. Medline
II Supportive (Green) 1 month neurologically favourable survival Patient Ohashi-Fukuda N., Fukuda T., Doi K., Morimura N. Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest. Resuscitation 2017; 114:66-72. Medline
II Neutral (Yellow) Mortality Patient PH-Paramedic & CCT Weihing VK, Crowe EH, Wang HE, Ugalde IT. Prehospital airway management in the pediatric patient: A systematic review. Acad Emerg Med 2021. Medline

Combitube (without AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) survival to discharge Process PH-Paramedic Hansen ML., Lin A., Eriksson C., Daya M., McNally B., Fu R., et al. A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database. Resuscitation 2017; 120 51-6. Medline

Laryngeal Tube (without AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Proportion of patients in whom effective spontaneous or assisted ventilation Patient OR Bortone L., et al. RCT comparing the LT and the laryngeal mask in pediatric patients. Ped Anesth 2006; 16:251-7. Medline
II Neutral (Yellow) survival to discharge Process PH-Paramedic Hansen ML., Lin A., Eriksson C., Daya M., McNally B., Fu R., et al. A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database. Resuscitation 2017; 120 51-6. Medline
II Neutral (Yellow) Mortality Patient Other Weihing VK, Crowe EH, Wang HE, Ugalde IT. Prehospital airway management in the pediatric patient: A systematic review. Acad Emerg Med 2021. Medline
III Supportive (Green) time to ventilation Process SIM Byars DV., Brodsky RA., Evans D., Lo B., Guins T., Perkins AM. Comparison of direct laryngoscopy to pediatric king LT-D in simulated airways. Pediatr Emerg Care 2012; 28(8):750-2. Medline
III Supportive (Green) Success Patient ED-MD Scheller B., et al. LT suction II for difficult airway management in neonates and small infants. Resuscitation 2009; 80:805-10. Medline
III Neutral (Yellow) Insertion speed Process SIM Mitchell MS., Lee White M., King WD., Wang HE. Paramedic King Laryngeal Tube airway insertion versus endotracheal intubation in simulated pediatric respiratory arrest. Prehosp Emerg Care 2012; 16(2):284-8. Medline
III Opposes (Red) Mortality and morbidity Patient PH-Paramedic Weihing VK, Crowe EH, Wang HE, Ugalde IT. Prehospital airway management in the pediatric patient: A systematic review. Acad Emerg Med 2021. Medline

LMA (without AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Proportion of patients in whom effective spontaneous or assisted ventilation Patient OR Bortone L., et al. RCT comparing the LT and the laryngeal mask in pediatric patients. Ped Anesth 2006; 16:251-7. Medline
I Neutral (Yellow) first attempt success Process OR Flynn P., Ahmed FB., Mitchell V., Patel A., Clark S. A randomised comparison of the single use LMA Flexible with the reusable LMA Flexible in paediatric dental day-case patients. Anaesthesia 2007; 62(12):1281-4. Medline
I Neutral (Yellow) First attempt success Process OR Jagannathan N., Sohn LE., Mankoo R., Langen KE., Mandler T. A randomized crossover comparison between the Laryngeal Mask Airway-Unique and the air-Q intubating laryngeal airway in children. Paediatr Anaesth 2012 Feb; 22(2):161-7. Medline
I Neutral (Yellow) Differences in SpO2 and PeCO2 Patient OR Sinha A., Sharma B., Sood J. ProSeal as an alternative to endotracheal intubation in pediatric laparoscopy. Paediatr Anaesth 2007; 17(4):327-332. Medline
II Neutral (Yellow) Intubation success Process SIM Komasawa N., Ueki R., Yamamoto N., et al. Comparison of air-Q(®) and soft seal(®) laryngeal mask for airway management by novice doctors during infant chest compression: A manikin study. Resuscitation 2012; 83(3):365-8. Medline
II Neutral (Yellow) Overall mortality Patient Other Weihing VK, Crowe EH, Wang HE, Ugalde IT. Prehospital airway management in the pediatric patient: A systematic review. Acad Emerg Med 2021. Medline
III Supportive (Green) time to ventilation Process SIM Chen L., Hsiao AL. Randomized trial of endotracheal tube versus laryngeal mask airway in simulated prehospital pediatric arrest. Pediatrics 2008; 122(2):e294-7. Medline
III Supportive (Green) Successful insertion Process PH-Paramedic MacConachie-Middleton P., Simpson P., Thomas R., Bendall J. Higher insertion success with the i-gel® supraglottic airway in out-of-hospital cardiac arrest: A randomised controlled trial. Resuscitation 2014; 85:7:893–897. Medline
III Supportive (Green) Time to AW insertion Process SIM Reiter DA., Strother CG., Weingart SD. The quality of cardiopulmonary resuscitation using supraglottic airways and intraosseous devices: A simulation trial. Resuscitation 2013; 84(1):93-7. Medline
III Neutral (Yellow) Ease of use Process OR Beylacq L., Bordes M., Semjen F., Cros AM. The I-gel, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: an observational study in children. Acta Anaesthesiol Scand 2009; 53(3):376-9. Medline

Percutaneous Cricothyrotomy
Level Direction Primary Outcome Patient/Process Setting Reference

Pharyngeal Tracheal Lumen (PTL)
Level Direction Primary Outcome Patient/Process Setting Reference


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