Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis

Although airway management is important in pediatric resuscitation, the effectiveness of bag-mask ventilation (BMV) and advanced airway management (AAM), such as endotracheal intubation (ETI) and supraglottic airway (SGA) devices, for prehospital resuscitation of pediatric out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to determine the efficacy of AAM during prehospital resuscitation of pediatric OHCA cases. We searched four databases from their inception to November 2022 and included randomized controlled trials and observational studies with appropriate adjustments for confounders that evaluated prehospital AAM for OHCA in children aged SGA > ETI. Although the available evidence is from observational studies and its certainty is low to very low, prehospital AAM for pediatric OHCA did not improve outcomes. •Network meta-analysis improves the detection power and accuracy by synthesizing direct and indirect comparisons.•Prehospital advanced airway management for pediatric OHCA does not improve outcomes.•Most of the available evidence was from observational studies.