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Journal update
Journal update
  1. Robert Hywel James1,2,
  2. Felix Wood1,2,
  3. Jonathon Lowe1,2,
  4. Mathias Ferrari3,
  5. Kara Hole3,
  6. Ed Benjamin Graham Barnard2,4,
  7. Laura Cottey2
  1. 1 Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
  2. 2 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 University of Plymouth, Plymouth, UK
  4. 4 EURECA, PACE Section Department of Medicine, Cambridge University, Cambridge, UK
  1. Correspondence to Dr Laura Cottey, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK; laurajcottey{at}gmail.com

https://doi.org/10.1136/emermed-2023-213872

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    This month’s update is by the Academic Department of Military Emergency Medicine and University Hospitals Plymouth NHS Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

    The papers are ranked as:

    • Worth a peek—interesting, but not yet ready for prime time.

    • Head turner—new concepts.

    • Game changer—this paper could/should change practice.

    Supraglottic airway versus tracheal intubation for airway management in out-of-hospital cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials by Forestell et al

    Topic: resuscitation

    Rating: head turner

    There is ongoing uncertainty regarding the ideal approach to airway management in out-of-hospital cardiac arrest (OHCA). This systematic review and meta-analysis compared the use of supraglottic airways (SGAs) with tracheal intubation in the initial management of adult OHCA.1

    Four randomised controlled trials were included with 13 412 adult patients in non-traumatic cardiac arrest. All RCTs randomised patients with OHCA to SGA or tracheal intubation for initial airway management. SGA use was associated with higher rates of return of spontaneous circulation (ROSC) (30.2% vs 27.8%) (relative risk (RR) 1.09; 95% CI 1.02 to 1.15; moderate certainty) and faster airway placement (mean difference 2.5 min less; 95% CI 1.6 to 3.4 min less; high certainty). For survival at longest follow-up, SGA use may have no effect (RR 1.06; 95% CI 0.84 to 1.34; low certainty) and has an uncertain effect on survival with good functional outcome (RR 1.11; 95% CI 0.82 to 1.50; very low certainty) and may have no effect on risk of aspiration (RR 1.04; 95% CI 0.94 to 1.16; low certainty). Bias of the studies was assessed with three of the included trials felt to be at low risk of bias and one study (Mulder et al 2) at high risk of bias.

    Limitations of this study include a small number of RCTs with variation in both types of SGA used …

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    Footnotes

    • Twitter @EmergencyDoc209, @JonathonLowe, @DefProfEM, @lauracottey

    • Contributors LC coordinated and edited the manuscript with equal contributions to the summaries and final manuscript by all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.