BVM
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Favorable neurological outcome at 28 days
|
Patient
|
|
Jabre P., Penaloza A., Pinero D. 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(8):779-787 Medline
|
|
I
|
Supportive (Green)
|
Survival to hospital discharge
|
Patient
|
PH-Paramedic & MD
|
Wang CH, Lee AF, Chang WT, et al. Comparing Effectiveness of Initial Airway Interventions for Out-of-Hospital Cardiac Arrest: A Systematic Review and Network Meta-analysis of Clinical Controlled Trials [published online ahead of print, 2020 Jan 23]. Ann Emerg Med. 2020;S0196-0644(19)31434-9. doi:10.1016/j.annemergmed.2019.12.003 Medline
|
|
I
|
Neutral (Yellow)
|
Ease and speed of placement
|
Process
|
OR
|
Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth 1995; 42(11):1017-23. Medline
|
|
I
|
Neutral (Yellow)
|
Ease of handling and efficacy of ventilation
|
Process
|
|
Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine; 25(1):104. Medline
|
|
I
|
Neutral (Yellow)
|
Success of airway management
|
Patient
|
PH-Paramedic
|
Jensen JL., Cheung KW., Tallon JM., Travers AH. Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: A systematic review. CJEM 2010; 12(2):135-40. Medline
|
|
I
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Lou J, Tian S, Kang X, et al. Airway management in out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med Dec 2022; 65:130-8. Medline
|
|
II
|
Supportive (Green)
|
Rate of oxygen desaturation/Hypoxia
|
Process
|
PH-Paramedic
|
Davis DP., Hwang JQ., Dunford JV. Rate of decline in O2 saturation at various pulse oximetry values with prehospital RSI. PEC 2008; 12:46-51. Medline
|
|
II
|
Supportive (Green)
|
Ease of handling and efficacy
|
Process
|
PH-Paramedic & MD
|
Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine 2017; 25(1):104. Medline
|
|
II
|
Supportive (Green)
|
Long-term Survival
|
Patient
|
PH-Paramedic
|
Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
|
|
II
|
Supportive (Green)
|
Survival to discharge
|
Process
|
PH-Paramedic
|
Hanif MA., Kaji AH., Niemann JT. Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Acad Emerg Med 2010; 17(9):926-31. Medline
|
|
II
|
Supportive (Green)
|
Favourable neurological outcome 1 month
|
Patient
|
PH-Paramedic
|
Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
|
|
II
|
Supportive (Green)
|
Multiple measures of chest compression interruptions
|
Process
|
|
Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-35. Medline
|
|
II
|
Supportive (Green)
|
chest compression interruption
|
Process
|
PH-Paramedic
|
Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-35. Medline
|
|
II
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
|
Jeong S., Ahn KO., Shin SD. The role of prehospital advanced airway management on outcomes for out-of-hospital cardiac arrest patients: a meta-analysis. Am J Emerg Med 2016; 34(11):2101-2106. Medline
|
|
II
|
Supportive (Green)
|
Survival
|
Process
|
PH-Paramedic
|
Ryan KM, Bui MD, Dugas JN, Zvonar I, Tobin JM. Impact of prehospital airway interventions on outcome in cardiac arrest following drowning: A study from the CARES Surveillance Group. Resuscitation 2021; 163:130–5. Medline
|
|
II
|
Supportive (Green)
|
PaO2
|
Patient
|
PH-Paramedic
|
Song SR, Kim KH, Park JH, Song KJ, Shin SD. Association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest. Am J Emerg Med March 2023; 65:24-30. Medline
|
|
II
|
Supportive (Green)
|
Arterial pH
|
Patient
|
PH-Paramedic
|
SOS-KANTO study group. Comparison of arterial blood gases of laryngeal mask airway and bag-valve-mask ventilation in out-of-hospital cardiac arrests. Circ J 2009; 73(3):490-496. Medline
|
|
II
|
Supportive (Green)
|
30-day survival
|
Patient
|
|
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 2018; 7(5):423-431. Medline
|
|
II
|
Neutral (Yellow)
|
Neurologically intact survival to hospital discharge
|
Patient
|
PH-Paramedic
|
Bobrow BJ., Ewy GA., Clark L., et al. Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med 2009; 54(5):656-62. Medline
|
|
II
|
Neutral (Yellow)
|
Neurological outcome
|
Patient
|
PH-Paramedic & MD
|
Carney N, Totten AM, Cheney T, Jungbauer R, Neth MR, Weeks C, et al. Prehospital Airway Management: A Systematic Review. Prehosp Emerg Care 2021; 1–28. Medline
|
|
II
|
Neutral (Yellow)
|
Ventilation efficacy
|
Process
|
OR
|
Dorges V., Ocker H., Hagelberg S., Wenzel V., Idris AH., Schmucker P. Smaller tidal volumes with room-air are not sufficient to ensure adequate oxygenation during bag-valve-mask ventilation. Resuscitation 2000; 44(1):37-41. Medline
|
|
II
|
Neutral (Yellow)
|
Chest compression Fraction
|
Process
|
PH-Paramedic
|
Maignan M., Koch FX., Kraemer M., et al. Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study. Resuscitation 2015; 93:113-7. Medline
|
|
III
|
Supportive (Green)
|
Minute volume delivery
|
Process
|
SIM
|
Lim JS., Cho YC., Kwon OY., Chung SP., Yu K., Kim SW. Precise minute ventilation delivery using a bag-valve mask and audible feedback. Am J Emerg Med 2012; 30(7):1068-71. Medline
|
|
III
|
Supportive (Green)
|
Mean tidal volume delivery.
|
Process
|
|
Reed P., Zobrist B., Casmaer M., Schauer SG., Kester N., April MD. Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial. Prehosp Disaster Med 2017; 1-6. Medline
|
|
III
|
Neutral (Yellow)
|
Success and efficacy of ventilation
|
Process
|
SIM
|
Fischer H., Hochbrugger E., Fast A., Hager H., Steinlechner B., Koinig H., et al. Performance of supraglottic airway devices and 12 month skill retention: a randomized controlled study with manikins. Resuscitation 2011; 82(3):326-31. Medline
|
|
III
|
Neutral (Yellow)
|
Tidal volume
|
Patient
|
SIM
|
Johannigman JA., Branson RD., Davis K Jr., Hurst JM. Techniques of emergency ventilation: A model to evaluate tidal volume, airway pressure, and gastric insufflation. J Trauma 1991; 31(1):93-8. Medline
|
|
III
|
Neutral (Yellow)
|
Ventilation performance
|
Process
|
SIM
|
Lee HY., Jeung KW., Lee BK., et al. The performances of standard and ResMed masks during bag-valve-mask ventilation. Prehosp Emerg Care 2013; 17(2):235-40. Medline
|
|
III
|
Opposes (Red)
|
Achievement of adequate tidal volumes
|
Process
|
|
Siegler J., Kroll M., Wojcik S., Moy HP. Can EMS Providers Provide Appropriate Tidal Volumes in a Simulated Adult-sized Patient with a Pediatric-sized Bag-Valve-Mask? Prehospital Emergency Care 2017; 21(1):74-78. Medline
|
Combitube (without AW reflexes)
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Neutral (Yellow)
|
Time to insertion
|
Process
|
OR
|
Gaitini LA., Yanovsky B., Somri M., Tome R., Mora PC., Frass M., et al. Prospective randomized comparison of the EasyTube and the esophageal-tracheal Combitube airway devices during general anesthesia with mechanical ventilation. J Clin Anesth 2011; 23(6):475-81. Medline
|
|
I
|
Neutral (Yellow)
|
Success of airway management
|
Patient
|
PH-Paramedic
|
Jensen JL., Cheung KW., Tallon JM., Travers AH. Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: A systematic review. CJEM 2010; 12(2):135-40. Medline
|
|
II
|
Supportive (Green)
|
One month survival with favorable neurological outcome
|
Patient
|
PH-Paramedic
|
Kajino K., Iwami T., Kitamura 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(5):R236. Medline
|
|
II
|
Supportive (Green)
|
Adequate ventilation
|
Process
|
OR
|
Wafai Y., Salem MR., Baraka A., Joseph NJ., Czinn EA., Paulissian R. Effectiveness of the self-inflating bulb for verification of proper placement of the Esophageal Tracheal Combitube. Anesth Analg 1995; 80(1):122-126. Medline
|
|
II
|
Neutral (Yellow)
|
ROSC, Survival to Discharge, Neuro intact Survival
|
Patient
|
PH-Paramedic
|
Benoit JL., Gerecht RB., Steuerwald MT., McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93:20-6. Medline
|
|
II
|
Neutral (Yellow)
|
ROSC, Survival to Admission/Discharge
|
Process
|
PH-Paramedic
|
Cady. Effect of EMT Placed Combitube on OOH Arrest Outcomes. Prehosp Emergency Care 2009; 13(4):495-9. Medline
|
|
II
|
Neutral (Yellow)
|
Success rate
|
Patient
|
PH-Paramedic
|
Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
|
|
II
|
Neutral (Yellow)
|
Successful insertion and ventilation
|
Process
|
|
Rumball C., Macdonald D., Barber P., Wong H., Smecher C. Endotracheal intubation and esophageal tracheal combitube insertion by regular ambulance attendants: A comparative trial. Prehosp Emerg Care 2004; 8(1):15-22. Medline
|
|
II
|
Neutral (Yellow)
|
Successful insertion
|
Process
|
OR
|
Verma RN, Sethi N, Honwad MS, Singh SK. Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management. Med J Armed Forces India 2021; 77(1):86-91. Medline
|
|
II
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Wang H., Szydlo D., Stouffer J., Lin S., Carlson J., Vaillancourt C., Sears G., Verbeek R., Fowler R., Idris R., Koenig K., Christenson J., Minokadeh A., Brandt J., Rea T. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 2012; 83:1061-1066. Medline
|
|
II
|
Opposes (Red)
|
Long-term Survival
|
Patient
|
PH-Paramedic
|
Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
|
|
II
|
Opposes (Red)
|
Favourable neurological outcome 1 month
|
Patient
|
PH-Paramedic
|
Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
|
|
II
|
Opposes (Red)
|
Overall success rate
|
Process
|
In-Patient
|
Verma RN, Sethi N, Honwad MS, Singh SK. Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management. Med J Armed Forces India 2021; 77(1):86-91. Medline
|
|
III
|
Supportive (Green)
|
Rate of success, time to success
|
Process
|
SIM
|
Bollig G., Lovhaug SW., Sagen O., Svendsen MV., Steen PA., Wik L. Airway management by paramedics using endotracheal intubation with a laryngoscope versus the oesophageal tracheal Combitube and EasyTube on manikins: a randomised experimental trial. Resuscitation 2006; 71(1):107-11. Medline
|
|
III
|
Supportive (Green)
|
Time to insertion, attempts
|
Process
|
SIM
|
Calkins MD., Robinson TD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma 1999; 46(5):927-32. Medline
|
|
III
|
Supportive (Green)
|
Successful insertion
|
Process
|
PH-Paramedic
|
Davis DP., Valentine C., Ochs M., Vilke GM., Hoyt DB. The Combitube as a salvage airway device for paramedic rapid sequence intubation. Ann Emerg Med 2003; 42(5):697-704. Medline
|
|
III
|
Supportive (Green)
|
Speed of insertion
|
Process
|
|
Sanfilippo F., Chiarenza F., Maybauer DM., Maybauer MO. The Easytube for airway management: a systematic review of clinical and simulation studies. J Clin Anesth 2016; 31:215-22. Medline
|
|
III
|
Neutral (Yellow)
|
Success, Time to success, Practitioner preference
|
Process
|
SIM
|
Tumpach EA., Lutes M., Ford D., Lerner EB. The King LT versus the Combitube: flight crew performance and preference. Prehosp Emerg Care 2009; 13(3):324-328. Medline
|
|
III
|
Opposes (Red)
|
successful ventilation
|
Process
|
PH-Paramedic
|
Dufour-Neyron H, Tanguay K, Nadeau A, Emond M, Harrisson J, Robert S, et al. Prehospital Use of the Esophageal Tracheal Combitube Supraglottic Airway Device: A Retrospective Cohort Study. J Emerg Med 2022. Medline
|
|
III
|
Opposes (Red)
|
Complications
|
Patient
|
PH-Paramedic
|
Vezina MC., Trepanier CA., Nicole PC., Lessard MR. Complications associated with the esophageal-tracheal combitube in the pre-hospital setting. Can J Anesth 2007; 54:124-8. Medliine
|
iGel
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
modified Rankin Scale (mRS) score at 30 days/hospital discharge
|
Patient
|
PH-Paramedic
|
Benger JR, Lazaroo MJ, Clout M, Voss S, Black S, Brett SJ, et al. Randomized trial of the i-gel supraglottic airway device versus tracheal intubation during out of hospital cardiac arrest (AIRWAYS-2): Patient outcomes at three and six months. Resuscitation 2020; 157:74-82. Medline
|
|
I
|
Supportive (Green)
|
ROSC of > 2hrs
|
Patient
|
PH-Paramedic
|
Lee AF, Chien YC, Lee BC, Yang WS, Wang YC, Lin HY, Huang EP, Chong KM, Sun JT, Huei-Ming M, Hsieh MJ, Chiang WC. Effect of Placement of a Supraglottic Airway Device vs Endotracheal Intubation on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest in Taipei, Taiwan: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2022; 5(2):e2148871. Medline
|
|
I
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
PH-Paramedic & MD
|
Lou J, Tian S, Kang X, et al. Airway management in out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med Dec 2022; 65:130-8. Medline
|
|
I
|
Neutral (Yellow)
|
Rankin Scale score at hospital discharge
or 30 days
|
Patient
|
PH-Paramedic
|
Benger J., Kirby K., Black S., 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 2018; 320(8):779-791 Medline
|
|
II
|
Supportive (Green)
|
Success rate
|
Process
|
PH-Paramedic
|
Duckett J, Fell P, Han K, Kimber C, Taylor C. Introduction of the I-gel supraglottic airway device for prehospital airway management in a UK ambulance service. Emerg Med J. 2014;31(6):505-507. doi:10.1136/emermed-2012-202126 Medline
|
|
II
|
Supportive (Green)
|
Clinical outcome of IGel in OHCA
|
Process
|
PH-Paramedic
|
Forestell B, Ramsden S, Sharif S, et al. Supraglottic Airway Versus Tracheal Intubation for Airway Management in Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Crit Care Med Nov 2023. Medline
|
|
II
|
Supportive (Green)
|
first-pass success ETI vs SGA
|
Process
|
PH-Paramedic
|
Levi D, Hoogendoorn J, Samuels S, et al. The i-gel(®) supraglottic airway device compared to endotracheal intubation as the initial prehospital advanced airway device: A natural experiment during the COVID-19 pandemic. J Am Coll Emerg Physicians Open April 2024; 5(2):e13150. Medline
|
|
II
|
Supportive (Green)
|
Attempts
|
Process
|
PH-Paramedic
|
Lønvik MP, Elden OE, Lunde MJ, Nordseth T, Bakkelund KE, Uleberg O. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 2021; 21(1):51. Medline
|
|
II
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care 2023; 1-13. Medline
|
|
II
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care 2023; 1-13. Medline
|
|
II
|
Supportive (Green)
|
Successful insertion
|
Process
|
OR
|
Verma RN, Sethi N, Honwad MS, Singh SK. Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management. Med J Armed Forces India 2021; 77(1):86-91. Medline
|
|
II
|
Neutral (Yellow)
|
Pre-cannulation PaO2
|
Patient
|
PH-Paramedic
|
Bartos JA, Clare Agdamag A, Kalra R, Nutting L, Frascone RJ, et al. Supraglottic Airway Devices are Associated with Asphyxial Physiology After Prolonged CPR in Patients with Refractory Out-of-Hospital Cardiac Arrest Presenting for Extracorporeal Cardiopulmonary Resuscitation. Resuscitation March 2023:109769. Medline
|
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
Other
|
Ryan KM, Bui MD, Dugas JN, Zvonar I, Tobin JM. Impact of prehospital airway interventions on outcome in cardiac arrest following drowning: A study from the CARES Surveillance Group. Resuscitation 2021; 163:130–5. Medline
|
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
ED-Paramedic & MD
|
Schauer SG, Hudson IL, Fisher AD, Dion G, et al. Improving Outcomes Associated with Prehospital Combat Airway Interventions: An Unrealized Opportunity. J Spec Oper Med 2023. Medline
|
|
II
|
Neutral (Yellow)
|
In-hospital mortality
|
Patient
|
Other
|
Weigeldt M, Schulz-Drost S, Stengel D, Lefering R, Treskatsch S, Berger C. In-hospital mortality after prehospital endotracheal intubation versus alternative methods of airway management in trauma patients. A cohort study from the TraumaRegister DGU®. Eur J Trauma Emerg Surg. March 2024. Medline
|
|
III
|
Supportive (Green)
|
Device insertion time
|
Process
|
|
An J., Nam SB., Lee JS., Lee J., Yoo H., Lee HM., et al. Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis. Medicine 2017; 96(1):e5801. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Benger J, Coates D, Davies S, 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(2):262-268. doi:10.1093/bja/aev477 Medline
|
|
III
|
Supportive (Green)
|
Success rates
|
Process
|
Other
|
Hansen ML, Wagner A, Schnapp A, Lin A, Le N, Deverman S, et al. Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room among paramedic students. Emerg Med J 2021; 38(1):27-32. Medline
|
|
III
|
Supportive (Green)
|
First pass success.
|
Process
|
PH-Paramedic
|
Häske D, Schempf B, Gaier G, Niederberger C. Performance of the i-gelTM during pre-hospital cardiopulmonary resuscitation.Resuscitation. 2013;84(9):1229-1232. doi:10.1016/j.resuscitation.2013.04.025 Medline
|
|
III
|
Supportive (Green)
|
Ventilatory success
|
Patient
|
PH-Paramedic
|
Häske D, Schempf B, Niederberger C, Gaier G. i-gel as alternative airway tool for difficult airway in severely injured patients. Am J Emerg Med. 2016;34(2):340.e1-4. doi:10.1016/j.ajem.2015.06.008 Medline
|
|
III
|
Supportive (Green)
|
Successful Insertion
|
Process
|
PH-Paramedic
|
Middleton PM, Simpson PM, Thomas RE, Bendall JC. 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. doi:10.1016/j.resuscitation.2014.02.021 Medline
|
|
III
|
Supportive (Green)
|
First pass success
|
Process
|
|
Wharton NM., Gibbison B., Gabbott DA., Haslam GM., Muchatuta N., Cook TM. I-gel insertion by novices in manikins and patients. Anaesthesia 2008; 63(9):991-5. Medline
|
|
III
|
Opposes (Red)
|
survival to discharge
|
Patient
|
Other
|
Ahn S, BY J, Cho H, Moon S, Cho YD, Park JH. Association of prehospital advanced airway and epinephrine with survival in patients with out-of-hospital cardiac arrest. Sci Rep October 2023; 13(1):17836. Medline
|
|
III
|
Opposes (Red)
|
Ability to ventilate
|
Process
|
PH-Paramedic
|
Baker PA, Webber JB. Failure to ventilate with supraglottic airways after drowning. Anaesth Intensive Care. 2011;39(4):675-677. http://www.ncbi.nlm.nih.gov/pubmed/21823389. Accessed March 13, 2019. Medline
|
Laryngeal Tube (without AW reflexes)
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Modified Rankin Score at discharge or 30 days
|
Patient
|
|
Benger J., Kirby K., Black S., 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 2018; 320(8):779-791 Medline
|
|
I
|
Supportive (Green)
|
Compression fraction
|
Process
|
PH-Paramedic
|
Deakin CD, Nolan JP, Ji C, Fothergill RT, Quinn T, Rosser A, et al. The effect of airway management on CPR quality in the PARAMEDIC2 randomised controlled trial. Resuscitation 2021; 158:8-13. Medline
|
|
I
|
Supportive (Green)
|
ROSC
|
Process
|
PH-Paramedic
|
Forestell B, Ramsden S, Sharif S, et al. Supraglottic Airway Versus Tracheal Intubation for Airway Management in Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Crit Care Med Nov 2023. Medline
|
|
I
|
Supportive (Green)
|
Survival to hospital discharge
|
Patient
|
PH-Paramedic & MD
|
Wang CH, Lee AF, Chang WT, et al. Comparing Effectiveness of Initial Airway Interventions for Out-of-Hospital Cardiac Arrest: A Systematic Review and Network Meta-analysis of Clinical Controlled Trials [published online ahead of print, 2020 Jan 23]. Ann Emerg Med. 2020;S0196-0644(19)31434-9. doi:10.1016/j.annemergmed.2019.12.003 Medline
|
|
I
|
Supportive (Green)
|
72-hour survival
|
Patient
|
|
Wang H., Schmicker R., Daya M. 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 2018; 320(8):769-778. Medline
|
|
I
|
Neutral (Yellow)
|
Ease of handling and efficacy of ventilation
|
Process
|
|
Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine; 25(1):104. Medline
|
|
I
|
Neutral (Yellow)
|
72 hour survival
|
Patient
|
PH-Paramedic
|
Lesnick JA, Moore JX, Zhang Y, Jarvis J, Nichol G, Daya MR, et al. Airway insertion first pass success and patient outcomes in adult out-of-hospital cardiac arrest: The Pragmatic Airway Resuscitation Trial. Resuscitation 2021; 158:151-6. Medline
|
|
I
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Lou J, Tian S, Kang X, et al. Airway management in out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med Dec 2022; 65:130-8. Medline
|
|
II
|
Supportive (Green)
|
First pass and overall insertion success.
|
Process
|
|
Bernhard M., Gries A., Ramshorn-Zimmer A., Wenzel V., Hossfeld B. Insertion Success of the Laryngeal Tube in Emergency Airway Management. BioMed research international 2016; 3619159. Medline
|
|
II
|
Supportive (Green)
|
ease of use and efficacy
|
Process
|
PH-Paramedic & MD
|
Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine 2017; 25(1):104. Medline
|
|
II
|
Supportive (Green)
|
First pass success rate
|
Process
|
|
Hilton MT., Wayne M., Martin-Gill C. Impact of System-Wide King LT Airway Implementation on Orotracheal Intubation. Prehospital emergency care 2016; 20(5):570-7. Medline
|
|
II
|
Supportive (Green)
|
Success rate
|
Process
|
|
Hiltunen P., Jäntti H., Silfvast T., Kuisma M., Kurola J. Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes. Scandinavian journal of trauma, resuscitation and emergency medicine 2016;24:49. Medline
|
|
II
|
Supportive (Green)
|
Success rate
|
Patient
|
PH-Paramedic
|
Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
|
|
II
|
Supportive (Green)
|
Multiple measures of chest compression interruptions
|
Process
|
|
Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-35. Medline
|
|
II
|
Supportive (Green)
|
Chest compression interruption
|
Process
|
PH-Paramedic
|
Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-35. Medline
|
|
II
|
Supportive (Green)
|
One month survival with favorable neurological outcome
|
Patient
|
PH-Paramedic
|
Kajino K., Iwami T., Kitamura 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(5):R236. Medline
|
|
II
|
Supportive (Green)
|
Successful rate of insertion
|
Patient
|
PH-Paramedic & MD
|
Lønvik MP, Elden OE, Lunde MJ, Nordseth T, Bakkelund KE, Uleberg O. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 2021; 21(1):51. Medline
|
|
II
|
Supportive (Green)
|
Chest compression Fraction
|
Process
|
PH-Paramedic
|
Maignan M., Koch FX., Kraemer M., et al. Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study. Resuscitation 2015; 93:113-7. Medline
|
|
II
|
Supportive (Green)
|
Adequate ventilation & oxygenation
|
Process
|
OR
|
Noor ZM., Khairul FA. Comparison of the VBM laryngeal tube and LMA for ventilation during manual in-line neck stabilization. Singapore Med J 2006; 47:892-6. Medline
|
|
II
|
Supportive (Green)
|
Safety and feasibility
|
Process
|
PH-Paramedic
|
Roth D., Hafner C., Aufmesser W., et al. Safety and feasibility of the laryngeal tube when used by EMTs during out-of-hospital cardiac arrest. Am J Emerg Med 2015; 33(8):1050-5. Medline
|
|
II
|
Supportive (Green)
|
Survival to Discharge
|
Patient
|
PH-Paramedic
|
Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care 2023; 1-13. Medline
|
|
II
|
Supportive (Green)
|
Successful insertion
|
Process
|
OR
|
Verma RN, Sethi N, Honwad MS, Singh SK. Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management. Med J Armed Forces India 2021; 77(1):86-91. Medline
|
|
II
|
Supportive (Green)
|
Overall success rate
|
Process
|
In-Patient
|
Verma RN, Sethi N, Honwad MS, Singh SK. Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management. Med J Armed Forces India 2021; 77(1):86-91. Medline
|
|
II
|
Neutral (Yellow)
|
EtCO2 during CPR
|
Process
|
|
Becker TK, Berning AW, Prabhu A, Callaway CW, Guyette FX, 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; 122:61-4. Medline
|
|
II
|
Neutral (Yellow)
|
ROSC, Survival to Discharge, Neuro intact Survival
|
Patient
|
PH-Paramedic
|
Benoit JL., Gerecht RB., Steuerwald MT., McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93:20-6. Medline
|
|
II
|
Neutral (Yellow)
|
Success, time
|
Process
|
OR
|
Cavus E., Deitmer W., Francksen H., Serocki G., Bein B., Scholz J., et al. Laryngeal tube S II, ProSeal laryngeal mask, and EasyTube during elective surgery: a randomized controlled comparison with the endotracheal tube in nontrained professionals. Eur J Anaesthesiol 2009; 26(9):730-35. Medline
|
|
II
|
Neutral (Yellow)
|
CPC score at 1 month
|
Patient
|
PH-Paramedic
|
Fukuda T, Ohashi-Fukuda N, Inokuchi R, Kondo Y, Sekiguchi H, Taira T, et al. Association between time to advanced airway management and neurologically favourable survival during out-of-hospital cardiac arrest. Anaesth Crit Care Pain 2021; 100906. Medline
|
|
II
|
Neutral (Yellow)
|
Chest compression interruptions
|
Process
|
|
Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-635. Medline
|
|
II
|
Neutral (Yellow)
|
PaCO2 and PaO2 levels
|
Patient
|
PH-Paramedic
|
Nakayama R, Bunya N, Uemura S, Sawamoto K, Narimatsu E. Prehospital advanced airway management and ventilation for out-of-hospital cardiac arrest with prehospital return of spontaneous circulation: a prospective observational cohort study in Japan. Prehosp Emerg Care Sept 2023; 1-12. Medline
|
|
II
|
Neutral (Yellow)
|
To examine the association between supraglottic airway device use (King LT or iGel) and the primary outcome of survival to hospital discharge with a favorable neurologic outcome in adults in the out of hospital environment suffering non traumatic cardiac
|
Patient
|
PH-Paramedic
|
Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care 2023; 1-13. Medline
|
|
II
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Wang H., Szydlo D., Stouffer J., Lin S., Carlson J., Vaillancourt C., Sears G., Verbeek R., Fowler R., Idris R., Koenig K., Christenson J., Minokadeh A., Brandt J., Rea T. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 2012; 83:1061-1066. Medline
|
|
II
|
Opposes (Red)
|
Long-term Survival
|
Patient
|
PH-Paramedic
|
Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
|
|
II
|
Opposes (Red)
|
Favourable neurological outcome 1 month
|
Patient
|
PH-Paramedic
|
Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
|
|
II
|
Opposes (Red)
|
Sustained ROSC
|
Patient
|
PH-Paramedic
|
McMullan J., Gerecht R., Bonomo .J, Robb R., McNally B., Donnelly J., Wang H. Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation 2014; 85(5):617–22. Medline
|
|
II
|
Opposes (Red)
|
30-day survival
|
Patient
|
|
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 2018; 7(5):423-431. Medline
|
|
III
|
Supportive (Green)
|
Ventilation
|
Process
|
SIM
|
Dorges V., et al. Intubating laryngeal mask airway, laryngeal tube, 1100mL self-inflating bag-alternatives for BLS? Resus 2001; 51:185-91. Medline
|
|
III
|
Supportive (Green)
|
Successful insertion
|
Process
|
|
Frascone RJ. Use of King LTS-D with Medication Assisted A/W Management. Prehospital Emerg Care 2009; 13(4):541-5. Medline
|
|
III
|
Supportive (Green)
|
Correct placement and ventilation
|
Process
|
SIM
|
Genzwuerker H, Hilker T, Hohner E, et al. The laryngeal tube: A new adjunct for airway management. Prehospital Emerg Care 2000; 4:168-72. Medline
|
|
III
|
Supportive (Green)
|
Correct placement and ventilation
|
Process
|
ED-MD
|
Genzwuerker HV., Dhonau S., Ellinger K. Use of the laryngeal tube for out-of-hospital resuscitation. Resus 2002; 52:221-4. Medline
|
|
III
|
Supportive (Green)
|
Chest Compression Fraction
|
Process
|
SIM
|
Jensen JL., Walker M., LeRoux Y., Carter A. Chest compression fraction in simulated cardiac arrest management by primary care paramedics: King laryngeal tube airway versus basic airway management. Prehosp Emerg Care 2013; 17(2):285-90. Medline
|
|
III
|
Supportive (Green)
|
Time to insertion and successful ventilation
|
Process
|
PH-Paramedic
|
Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. Medline
|
|
III
|
Supportive (Green)
|
Time to insertion and successful ventilation
|
Process
|
PH-Paramedic
|
Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. 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
|
Supportive (Green)
|
Success rate of blind intubation
|
Patient
|
SIM
|
Szarpak L., Kurowski A., Truszewski Z., Robak O., Frass M. Comparison of 4 supraglotttic devices used by paramedics during simulated CPR : A randomized controlled crossover trial. Am J Emerg Med 2015; 33(8):1084-1088. Medline
|
|
III
|
Supportive (Green)
|
Success, Time to success, Practitioner preference
|
Process
|
SIM
|
Tumpach EA., Lutes M., Ford D., Lerner EB. The King LT versus the Combitube: flight crew performance and preference. Prehosp Emerg Care 2009; 13(3):324-328. Medline
|
|
III
|
Neutral (Yellow)
|
Success
|
Patient
|
PH-Paramedic
|
Chan JJ, Goh ZX, Koh ZX, Soo JJE, Fergus J, Ng YY, et al. Clinical evaluation of the use of laryngeal tube verses laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore. Singapore Med J 2020. Medline
|
|
III
|
Neutral (Yellow)
|
Desaturations
|
Patient
|
OR
|
Kurola J., et al. Airway management in cardiac arrest - comparison of LT, TI, BMV in emergency medical training. Resus 2005; 61:149-53. Medline
|
|
III
|
Neutral (Yellow)
|
Success
|
Process
|
PH-Paramedic
|
Kurola JO., et al. A comparison of the laryngeal tube & BMV ventilation by EMTs: a feasibility study in anesthetized patients. Anesth Analg 2005; 101:1477-81. Medline
|
|
III
|
Neutral (Yellow)
|
Successful insertion & ventilation
|
Process
|
PH-Paramedic
|
Rumball CJ., MacDondald D. The PTL, combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997; 1:1-10. Medline
|
|
III
|
Neutral (Yellow)
|
Success, time
|
Process
|
SIM
|
Russi CS., Miller L., Hartley MJ. A comparison of the King-LT to ETI and Combitube in Simulated Difficult Airway. PEC 2008; 12:35-41. MedLine
|
|
III
|
Neutral (Yellow)
|
Functional of-hospital airway management in the United States
|
Patient
|
PH-Paramedic
|
Wang HE., Mann NC., Mears G., Jacobson K., Yealy D. Out-of-hospital airway management in the United States. Resuscitation 2011; 82(4):378–385. Medline
|
|
III
|
Neutral (Yellow)
|
CPR (no flow time)
|
Patient
|
SIM
|
Weise CHR., Bahr J., Popov AF., Hinz JM., Graf BM. Influence of airway management strategy on 'no flow time' in a standardized single rescuer manikin scenario. Resus 2009; 80:100-3. Medline
|
|
III
|
Neutral (Yellow)
|
Reduction in no flow time
|
Patient
|
SIM
|
Wiese CH., Bartels U., Bergmann A., Bergmann I., Bahr J., Graf BM. Using a laryngeal tube during cardiac arrest reduces "no flow time" in a manikin study: A comparison between laryngeal tube and endotracheal tube. Wien Klin Wochenschr 2008; 120(7-8):217-223. Medline
|
LMA (without AW reflexes)
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Ease and speed of placement
|
Process
|
OR
|
Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth 1995; 42(11):1017-23. Medline
|
|
I
|
Supportive (Green)
|
ROSC
|
Process
|
PH-Paramedic
|
Forestell B, Ramsden S, Sharif S, et al. Supraglottic Airway Versus Tracheal Intubation for Airway Management in Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Crit Care Med Nov 2023. Medline
|
|
I
|
Neutral (Yellow)
|
Time to ventilation
|
Process
|
Other
|
Hansen ML, Wagner A, Schnapp A, Lin A, Le N, Deverman S, et al. Cluster cross-over randomised trial of paediatric airway management devices in the simulation lab and operating room among paramedic students. Emerg Med J 2021; 38(1):27-32. Medline
|
|
I
|
Neutral (Yellow)
|
Success of airway management
|
Patient
|
PH-Paramedic
|
Jensen JL., Cheung KW., Tallon JM., Travers AH. Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: A systematic review. CJEM 2010; 12(2):135-40. Medline
|
|
I
|
Neutral (Yellow)
|
airway-related complications
|
Patient
|
OR
|
Yu SH., Beirne OR. Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review. J Oral Maxillofac Surg 2010; 68(10):2359-2376. Medline
|
|
II
|
Supportive (Green)
|
One-month neurologically favourable survival
|
Patient
|
PH-Paramedic
|
Fukuda T, Ohashi-Fukuda N, Inokuchi R, Kondo Y, Sekiguchi H, Taira T, et al. Association between time to advanced airway management and neurologically favourable survival during out-of-hospital cardiac arrest. Anaesth Crit Care Pain 2021; 100906. Medline
|
|
II
|
Supportive (Green)
|
Success rate
|
Process
|
|
Hiltunen P., Jäntti H., Silfvast T., Kuisma M., Kurola J. Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes. Scandinavian journal of trauma, resuscitation and emergency medicine 2016;24:49. Medline
|
|
II
|
Supportive (Green)
|
Adequate ventilation & oxygenation
|
Process
|
OR
|
Noor ZM., Khairul FA. Comparison of the VBM laryngeal tube and LMA for ventilation during manual in-line neck stabilization. Singapore Med J 2006; 47:892-6. Medline
|
|
II
|
Neutral (Yellow)
|
Success
|
Process
|
OR
|
Ali A., Canturk S., Turkmen A., Turgut N., Altan A. Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults. Eur J Anaesthesiol 2009; 26(12):1010-4. Medline
|
|
II
|
Neutral (Yellow)
|
PaO2
|
Patient
|
PH-Paramedic
|
Bartos JA, Clare Agdamag A, Kalra R, Nutting L, Frascone RJ, et al. Supraglottic Airway Devices are Associated with Asphyxial Physiology After Prolonged CPR in Patients with Refractory Out-of-Hospital Cardiac Arrest Presenting for Extracorporeal Cardiopulmonary Resuscitation. Resuscitation March 2023:109769. Medline
|
|
II
|
Neutral (Yellow)
|
ROSC, Survival to Discharge, Neuro intact Survival
|
Patient
|
PH-Paramedic
|
Benoit JL., Gerecht RB., Steuerwald MT., McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93:20-6. Medline
|
|
II
|
Neutral (Yellow)
|
Success, time
|
Process
|
OR
|
Cavus E., Deitmer W., Francksen H., Serocki G., Bein B., Scholz J., et al. Laryngeal tube S II, ProSeal laryngeal mask, and EasyTube during elective surgery: a randomized controlled comparison with the endotracheal tube in nontrained professionals. Eur J Anaesthesiol 2009; 26(9):730-35. Medline
|
|
II
|
Neutral (Yellow)
|
Success rate
|
Patient
|
PH-Paramedic
|
Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
|
|
II
|
Neutral (Yellow)
|
One month survival with favorable neurological outcome
|
Patient
|
PH-Paramedic
|
Kajino K., Iwami T., Kitamura 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(5):R236. Medline
|
|
II
|
Neutral (Yellow)
|
PaCO2 and PaO2 levels
|
Patient
|
PH-Paramedic
|
Nakayama R, Bunya N, Uemura S, Sawamoto K, Narimatsu E. Prehospital advanced airway management and ventilation for out-of-hospital cardiac arrest with prehospital return of spontaneous circulation: a prospective observational cohort study in Japan. Prehosp Emerg Care Sept 2023; 1-12. Medline
|
|
II
|
Neutral (Yellow)
|
Arterial pH
|
Patient
|
PH-Paramedic
|
SOS-KANTO study group. Comparison of arterial blood gases of laryngeal mask airway and bag-valve-mask ventilation in out-of-hospital cardiac arrests. Circ J 2009; 73(3):490-496. Medline
|
|
II
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Wang H., Szydlo D., Stouffer J., Lin S., Carlson J., Vaillancourt C., Sears G., Verbeek R., Fowler R., Idris R., Koenig K., Christenson J., Minokadeh A., Brandt J., Rea T. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 2012; 83:1061-1066. Medline
|
|
II
|
Neutral (Yellow)
|
Success, time to ventilation
|
Process
|
OR
|
Yardy N., Hancox D., Strang T. A comparison of two airway aids for emergency use by unskilled personnel. The Combitube and laryngeal mask. Anaesthesia 1999; 54(2):181-183. Medline
|
|
II
|
Opposes (Red)
|
Long-term Survival
|
Patient
|
PH-Paramedic
|
Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
|
|
II
|
Opposes (Red)
|
Favourable neurological outcome 1 month
|
Patient
|
PH-Paramedic
|
Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
|
|
II
|
Opposes (Red)
|
Neurologically favourable survival at one month
|
Patient
|
|
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(3):375-83. Medline
|
|
II
|
Opposes (Red)
|
Neurologically favorable 1-month survival
|
Patient
|
PH-Paramedic
|
Tanabe S., Ogawa T., Akahane M., 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(2):389-397. Medline
|
|
II
|
Opposes (Red)
|
Operator efficacy
|
Process
|
In-Patient
|
Verma RN, Sethi N, Honwad MS, Singh SK. Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management. Med J Armed Forces India 2021; 77(1):86-91. Medline
|
|
III
|
Supportive (Green)
|
Time to insertion, attempts
|
Process
|
SIM
|
Calkins MD., Robinson TD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma 1999; 46(5):927-32. Medline
|
|
III
|
Supportive (Green)
|
Success
|
Patient
|
PH-Paramedic
|
Chan JJ, Goh ZX, Koh ZX, Soo JJE, Fergus J, Ng YY, et al. Clinical evaluation of the use of laryngeal tube verses laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore. Singapore Med J 2020. Medline
|
|
III
|
Supportive (Green)
|
Ventilation
|
Process
|
SIM
|
Dorges V., et al. Intubating laryngeal mask airway, laryngeal tube, 1100mL self-inflating bag-alternatives for BLS? Resus 2001; 51:185-91. Medline
|
|
III
|
Supportive (Green)
|
Success
|
Process
|
PH-Paramedic
|
Grier G., Bredmose P., Davies G., Lockey D. Introduction and use of the ProSeal LMA as a rescue device in a prehospital trauma anaesthesia algorithm. Resus 2009; 80:138-41. 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)
|
Training success
|
Process
|
SIM
|
Murray MJ., Vermeulen MJ., Morrison LJ. Evaluation of prehospital insertion of the laryngeal mask airway by primary care paramedics with only classroom mannequin training. CJEM 2002; 4:338-43. Medline
|
|
III
|
Supportive (Green)
|
Time to insertion and successful ventilation
|
Process
|
PH-Paramedic
|
Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. Medline
|
|
III
|
Supportive (Green)
|
Time to insertion and successful ventilation
|
Process
|
PH-Paramedic
|
Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. Medline
|
|
III
|
Supportive (Green)
|
Time to insertion
|
Process
|
SIM
|
Ozbek AE, Sanci E. Comparison of Jaw-Thrust Maneuver and Standard Method for Airway Management with Laryngeal Mask Airway by Paramedics during Chest Compression: A Randomized, Crossover, Manikin Study. Prehosp Disaster Med 2022; 37(3):378–82. 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
|
Supportive (Green)
|
Time to placement
|
Process
|
SIM
|
Southard A., Braude D., Crandall C. Rapid sequence airway vs rapid sequence intubation in a simulated trauma airway by flight crew. Resuscitation 2010; 81(5):576-578. Medline
|
|
III
|
Supportive (Green)
|
Success rate of blind intubation
|
Patient
|
SIM
|
Szarpak L., Kurowski A., Truszewski Z., Robak O., Frass M. Comparison of 4 supraglotttic devices used by paramedics during simulated CPR : A randomized controlled crossover trial. Am J Emerg Med 2015; 33(8):1084-1088. Medline
|
|
III
|
Supportive (Green)
|
Endotracheal intubation (ETI) attempts, success rates
|
Patient
|
|
Thomas S., Judge T., Lowell MJ., et al. Airway management success and hypoxemia rates in air and ground critical care transport: A prospective multicenter study. Prehosp Emerg Care 2010; 14(3):283. Medline
|
|
III
|
Neutral (Yellow)
|
Success rate
|
Process
|
SIM
|
Amathieu R., Sudrial J., Abdi W., Luis D., Hahouache H., Combes X., et al. Simulating face-to-face tracheal intubation of a trapped patient: a randomized comparison of the LMA Fastrach™, the GlideScope™, and the Airtraq™ laryngoscope. Br J Anaesth 2012; 108(1):140-5. Medline
|
|
III
|
Neutral (Yellow)
|
Device insertion time
|
Process
|
|
An J., Nam SB., Lee JS., Lee J., Yoo H., Lee HM., et al. Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis. Medicine 2017; 96(1):e5801. Medline
|
|
III
|
Neutral (Yellow)
|
Success and efficacy of ventilation
|
Process
|
SIM
|
Fischer H., Hochbrugger E., Fast A., Hager H., Steinlechner B., Koinig H., et al. Performance of supraglottic airway devices and 12 month skill retention: a randomized controlled study with manikins. Resuscitation 2011; 82(3):326-31. Medline
|
|
III
|
Neutral (Yellow)
|
Prevalence of LMA use
|
Patient
|
PH-Paramedic
|
Hulme J., Perkins GD. Critically injured patients, inaccessible airways, and laryngeal mask airways. Emerg Med J 2005; 22:742-4. Medline
|
|
III
|
Neutral (Yellow)
|
Successful insertion & ventilation
|
Process
|
PH-Paramedic
|
Rumball CJ., MacDondald D. The PTL, combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997; 1:1-10. Medline
|
|
III
|
Neutral (Yellow)
|
Functional of-hospital airway management in the United States
|
Patient
|
PH-Paramedic
|
Wang HE., Mann NC., Mears G., Jacobson K., Yealy D. Out-of-hospital airway management in the United States. Resuscitation 2011; 82(4):378–385. Medline
|
Surgical Cricothyrotomy
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Neutral (Yellow)
|
FONA rate of use and success in HEMS service
|
Process
|
Other
|
Ljungqvist H, Tommila M, Setälä P, et al. Front of neck airway in Finnish helicopter emergency medical services. Injury June 2024; 55(8):111689. Medline
|
|
II
|
Supportive (Green)
|
Successful placement
|
Process
|
PH-Paramedic
|
Brown LH., Hubble MW., Wilfong DA., Hertelendy A., Benner RW. Airway management in the air medical setting. Air Med J 2011; 30(3):140-8. Medline
|
|
II
|
Supportive (Green)
|
Success rate
|
Patient
|
PH-Paramedic
|
Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
|
|
II
|
Supportive (Green)
|
Success
|
Process
|
SIM
|
Keane MF., Brinsfield KH., Dyer KS., Roy S., White D. A laboratory comparison of emergency percutaneous and surgical cricothyrotomy by prehospital personnel. Prehosp Emerg Care 2004; 8(4):424-6. Medline
|
|
II
|
Supportive (Green)
|
Success
|
Process
|
PH-Paramedic & MD
|
Morton S, Avery P, Kua J, O’Meara M. Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis. Br J Anaesth 2023. Medline
|
|
II
|
Supportive (Green)
|
Success rate
|
Process
|
PH-Paramedic & MD
|
Schober P., Biesheuvel T., de LM, Loer SA., Schwarte LA. Prehospital cricothyrotomies in a helicopter emergency medical service analysis of 19,382 dispatches. BMC emergency medicine 2019; 19(1) 12. Medline
|
|
II
|
Supportive (Green)
|
Observational post-cricothyrotomy outcomes
|
Patient
|
PH-Paramedic & MD
|
Tsur N, Talmy T, Rittblat M, Radomislensky I, Almog O, Gendler S. Long-term Outcomes of Cricothyroidotomy Versus Endotracheal Intubation in Military Personnel: A Retrospective Comparative Analysis Cohort Study. J Surg Res June 2024; 300:416-24. Medline
|
|
III
|
Supportive (Green)
|
Competency description of cricothyrotomy
|
Process
|
PH-Paramedic & CCT
|
Andresen ÅEL, Kramer-Johansen J, Kristiansen T. Emergency cricothyroidotomy in difficult airway simulation - a national observational study of Air Ambulance crew performance. BMC Emerg Med 2022; 22(1):64. Medline
|
|
III
|
Supportive (Green)
|
Accuracy of placement
|
Process
|
ED-MD
|
Chan TC., Vilke GM., Bramwell KJ., Davis DP., Hamilton RS., Rosen P. Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. J Emerg Med 1999; 17(6):957-62. Medline
|
|
III
|
Supportive (Green)
|
Success rate
|
Process
|
PH-Paramedic
|
Lulla A, Dickson R, Wells M, Gilbert M, Rogers Keene K, Patrick C. Prehospital Surgical Cricothyrotomy in a Ground-Based 9-1-1 EMS System: A Retrospective Review. Prehosp Disaster Med April 2024; 1-4. Medline
|
|
III
|
Neutral (Yellow)
|
Procedure duration, failure rate
|
Process
|
SIM
|
Benkhadra M., Lenfant F., Nemetz W., Anderhuber F., Feigl G., Fasel J. A comparison of two emergency cricothyroidotomy kits in human cadavers. Anesth Analg 2008; 106(1):182-5. Medline
|
|
III
|
Neutral (Yellow)
|
Time to first ventilation
|
Process
|
SIM
|
Dimitriadis JC., Paoloni R. Emergency cricothyroidotomy: a randomised crossover study of four methods. Anaesthesia 2008; 63(11):1204-8. Medline
|
|
III
|
Neutral (Yellow)
|
ROSC
|
Process
|
ED-MD
|
Graham CA., Yu AH., Chan SS., Rainer TH. Primary emergency surgical airway for trismus caused by electrical burn. Burns 2006; 32(8):1062-3. Medline
|
|
III
|
Neutral (Yellow)
|
Correct diagnosis
|
Process
|
ED-MD
|
Johnson DR., Dunlap A., McFeeley P., et al. Cricothyrotomy performed by prehospital personnel: A comparison of two techniques in a human cadaver model. Am J Emerg Med 1993; 11:207-9. Medline
|
|
III
|
Neutral (Yellow)
|
correct performance of intervention
|
Patient
|
PH-Paramedic
|
Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
|
|
III
|
Neutral (Yellow)
|
successful placement
|
Process
|
ED-MD
|
Langvad S., Hyldmo PK., Nakstad AR., Vist GE., Sandberg M. Emergency cricothyrotomy--a systematic review. Scand J Trauma Resusc Emerg Med 2013; 21:43. Medline
|
|
III
|
Neutral (Yellow)
|
Time to successful cricothyrotomy cannulation
|
Process
|
SIM
|
Schauer SG., D FJ, L RJ, Brown D., L JK, Srichandra J., et al. A randomized cross-over study comparing surgical cricothyrotomy techniques by combat medics using a synthetic cadaver model. Am J Emerg Med 2018; 36(4) 651-6. Medline
|
|
III
|
Neutral (Yellow)
|
Airway success rate
|
Patient
|
PH-Paramedic & MD
|
Smith S, Liu M, Ball I, Meunier B, Hilsden R. A Systematic Review of Prehospital Combat Airway Management. J Spec Oper Med 2023. Medline
|
|
III
|
Neutral (Yellow)
|
Safety and efficacy
|
Patient
|
PH-Paramedic
|
Spaite DW., Joseph M. Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome. Ann Emerg Med 1990; 19:279-285. Medline
|
|
III
|
Neutral (Yellow)
|
Practitioner preference, time to ventilation, complications, number of attempts
|
Patient
|
SIM
|
Sulaiman L., Tighe SQ., Nelson RA. Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion. Anaesthesia 2006; 61(6):565-570. Medline
|
|
III
|
Neutral (Yellow)
|
Success
|
Patient
|
ED-MD
|
Walls RM., Pollack CV., Jr. Successful cricothyrotomy after thrombolytic therapy for acute myocardial infarction: a report of two cases. Ann Emerg Med 2000; 35(2):188-191. Medline
|
|
III
|
Opposes (Red)
|
Syncopal etiology
|
Process
|
ED-MD
|
Fortune JB., Judkins DG., Scanzaroli D., et al. Efficacy of prehospital surgical cricothyrotomy in trauma patients. J Trauma, Injury, Infection and Critical Care 1997; 42:836-8. Medline
|