Application of assisted ventilation strategies to advanced life support in the patients of cardiac arrest:network Meta-analysis and systematic review

Zhao Zhenyu; Zhang Na; Wei Ping; Zhao Yajuan; Zhang Hua

doi:10.3969/j.issn.1002-1949.2025.07.004

Abstract：Objective To compare the efficacy of different assisted ventilation methods in cardiac arrest(CA)patients.Methods A systematic search was conducted in databases such as OVID,PubMed,Web of Science,Embase,Cochrane,CNKI,Wanfang Data and VIP,and a network Meta-analysis was performed by manually searching the references of relevant articles.The primary outcome was the rate of return of spontaneous circulation(ROSC),and secondary outcomes included the success rate of assisted ventilation,survival rate in hospital and survival rate of discharge.Results This network Meta-analysis included 19 randomized controlled trials involving 17 799 patients,and assessed seven commonly used assisted ventilation methods,including endotracheal intubation(ETI),supraglottic airway ventilation[which can be further divided into laryngeal mask(LM),laryngeal tube(LT),combined esophageal-tracheal cannula(ETC),and i-Gel laryngeal mask],bag-valve-mask ventilation(BM),and BM combined with ETI assisted ventilation.The results showed that in terms of spontaneous circulation recovery,BM combined with ETI had the best effect compared to ETI(OR=6.16,95％CI 1.55-28.04),and compared to BM(OR=8.91,95％CI 1.99-61.54),with statistically significant differences.The relative ranking of the efficacy of each intervention was BM+ETI＞ETC＞LT＞LM＞BM＞i-Gel＞ETI.In terms of survival rate of discharge,BM combined with ETI also had the best effect compared to BM(OR=4.67,95％CI 1.82-10.77),compared to ETI(OR=4.65,95％CI 1.87-11.43),compared to i-Gel(OR=4.31,95％CI 1.53-12.50),compared to LM(OR=5.88,95％CI 1.43-23.34),and compared to LT(OR=3.37,95％CI 1.17-9.74),with statistically significant differences.The relative ranking of the efficacy of each intervention was BM+ETI＞ETC＞LT＞LM＞BM＞i-Gel＞ETI.Conclusions Although ETI has always been considered the preferred assisted ventilation strategy for CA patients,it dose not show superiority over other assisted ventilation strategies in prospective studies.Each assisted ventilation strategy has its own strengths and weaknesses,and the therapeutic effect of the combined therapy after prioritizing BM for stable ventilation before intubation is the highest.This suggests that the choice of assisted ventilation strategy needs to be judged based on the patient's and operator's conditions.