SGAs (Combitube, LMA, Laryngeal Tube) Versus Tracheal Intubation
For the critical outcome of favorable neurologic survival, we have identified very-low-quality evidence (downgraded for very serious concerns about risk of bias, inconsistency, and indirectness) from 1 observational study of 5377 OHCAs showing no difference between tracheal intubation and insertion of a SGA (adjusted OR, 0.71; 95% CI, 0.39–1.30),(Kajino 2011, R236) from 1 observational study of 281 522 OHCAs showing higher rates of favorable neurologic outcome between insertion of an SGA and tracheal intubation (OR, 1.11; 95% CI, 1.0–1.2)(Hasegawa 2013, 257) and from 2 studies showing higher rates of favorable neurologic outcome between tracheal intubation and insertion of an SGA (8701 OHCAs: adjusted OR, 1.44; 95% CI, 1.10–1.88)(McMullan 2014, 617) and (10 455 OHCAs: adjusted OR, 1.40; 95% CI, 1.04–1.89).(Wang 2012, 1061)
SGAs (EOA and LMA) Versus Tracheal Intubation
For the critical outcome of neurologically favorable 1-month survival, we have identified very-low-quality evidence (downgraded for very serious risk of bias, inconsistency, indirectness, and imprecision) from 1 observational study of 138 248 OHCAs that showed higher rates of neurologically favorable 1-month survival with tracheal intubation compared with insertion of an EOA or LMA (OR, 0.89; 95% CI, 0.8–1.0).(Tanabe 2013, 389)
For the critical outcome of 1-month survival, we have identified very-low-quality evidence (downgraded for very serious concerns about risk of bias, inconsistency, indirectness, and imprecision) from 1 observational study that showed no difference in 1-month survival between tracheal intubation and insertion of an EOA of an LMA (OR, 0.75; 95% CI, 0.3–1.9)(Takei 2010, 716) and very-low-quality evidence (downgraded for very serious risk of bias, inconsistency, indirectness, and imprecision) from another observation study that showed higher 1-month survival with tracheal intubation compared with insertion of an EOA of an LMA (OR, 1.03; 95% CI, 0.9–1.1).(Tanabe 2013, 389)
LMA (I) Versus Tracheal Intubation (C)
For the critical outcome of survival to hospital discharge, we have identified very-low-quality evidence (downgraded for very serious risk of bias, inconsistency, indirectness, and imprecision) from 1 observational study of 641 OHCAs that showed lower rates of survival to hospital discharge with insertion of an LMA compared with tracheal tube (OR, 0.69; 95% CI, 0.4–1.3).(Shin 2012, 313)
Esophageal Gastric Tube Airway (I) Versus Tracheal Intubation (C)
For the critical outcome of survival to hospital discharge, we have identified very-low-quality evidence (downgraded for very serious risk of bias and imprecision) from 1 RCT enrolling 175 OHCAs showing no difference between esophageal gastric tube airway and tracheal intubation (OR, 1.19; 95% CI, 0.5–3.0).(Goldenberg 1986, 90)
Combitube (I) Versus Tracheal Intubation (C)
For the critical outcome of survival to hospital discharge, we have identified very-low-quality evidence (downgraded for very serious risk of bias, inconsistency, indirectness, and imprecision) from 1 RCT enrolling 173 OHCAs that showed no difference between Combitube and tracheal intubation (OR, 2.38; 95% CI, 0.5–12.1)(Rabitsch 2003, 27) and very-low-quality evidence from 1 observational study of 5822 OHCAs that showed no difference between tracheal intubation by paramedics, and Combitube insertion by emergency medical technicians (adjusted OR, 1.02; 95% CI, 0.79–1.30).(Cady 2009, 495)
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