Use of supraglottic airway devices by paramedics in the management of adult prehospital cardiac arrest patients.

Stephen Barr, Gavin Smith, Shaunagh Darroch



Current best practice for paramedic airway management of prehospital cardiac arrest is being continually reviewed following changes to the emphasis on intubation as a primary intervention within international resuscitation guidelines. Subsequently, there is increased enthusiasm for the use of next generation supraglottic airway devices. This review aimed to identify the current evidence for the safety and effectiveness of supraglottic airways for the management of prehospital cardiac arrest.


A search of the electronic databases Medline, PubMed, Science Direct and Cochrane Library was conducted. Papers were excluded if they did not examine airway management in the prehospital cardiac arrest setting, involved the use of sedative or paralysing agents, involved paediatric patients, animals or cadavers.


Of the 689 articles identified, 22 peer-reviewed articles were included for analysis. All 22 articles were from the following countries: America (3), America and Canada (1), Australia (2), Austria (1), Finland (1), Germany (4), Korea (1), Japan (4), The Netherlands (1), Norway (1), Taiwan (1), and United Kingdom (2).


This review revealed large variances in both device effectiveness and patient outcome, particularly between geographical locations. Second-generation supraglottic airway devices demonstrated considerable improvement in effectiveness over their predecessors. Interestingly, the use of bag-valve mask ventilation reported better outcomes than any other form of advanced airway intervention. Studies also highlighted the diversity of airway management techniques and devices across global EMS systems.


Despite favourable indications of the effectiveness and safety of the next generation supraglottic airway devices, the paucity of prehospital-specific research (particularly randomised controlled trials) challenges decision making regarding prehospital airway management best practice.


Supraglottic airway device, prehospital, effectiveness

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