Advanced airway interventions for paediatric cardiac arrest: updated systematic review and meta-analysis
Bibliographic record
Abstract
Background: Airway management is vital in paediatric resuscitation, especially since respiratory conditions are frequently the primary cause of paediatric cardiac arrest. Placement of an advanced airway device may facilitate more effective resuscitation than bag-mask ventilation but requires more skilled personnel and the time taken to perform the procedure may interfere with other vital components of resuscitation. Objectives: To assess the use of advanced airway interventions, tracheal intubation (TI) or supraglottic airway (SGA) placement, compared with bag mask ventilation (BMV) alone for resuscitation of children in cardiac arrest. Data sources: This was an update to a previous systematic review performed by ILCOR. A search of PubMed, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) was conducted for suitable studies published before 1 January 2025. This systematic review was registered as PROSPERO CRD42023482459. Study eligibility: Randomised controlled trials and non-randomised comparison studies involving airway interventions (BMV, TI, SGA) in infants and children (excluding newborn infants) in cardiac arrest in any setting were included. Study appraisal & synthesis: Investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the RoB 2 and CLARITY frameworks. Critically important outcomes included survival to hospital discharge and survival with good neurological outcome. Results: -analysis. The majority of studies involved out-of-hospital cardiac arrest, with few studies exploring in-hospital cardiac arrest. The overall certainty of evidence was low to very low. For the critically important outcomes of survival to hospital discharge with good neurologic outcome and survival to hospital discharge, results showed no benefit from advanced airway interventions (TI or SGA) over BMV. Conclusions: There is currently no supporting evidence that an advanced airway (supraglottic airway or tracheal intubation) during CPR improves survival or survival with a good neurological outcome after paediatric cardiac arrest in any setting when compared with bag-mask ventilation.Well-designed randomised trials are needed to address this important question.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.047 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.038 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".