Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review

Abstract

Background: Bag-valve-mask ventilation is the most commonly applied method during cardiopulmonary resuscitation. Globally, advanced airway management with blind insertion devices such as supraglottic airway devices has been implemented for years by different emergency services. The efficiency of ventilation via such devices could be measured by capnography.

Objective: The objective of this study was to determine whether capnography is useful in patients undergoing cardiopulmonary resuscitation and to assess the effectiveness of ventilation via supraglottic airway devices.

Review methods used: This is a systematic review written following the steps of Preferred Reporting Items for Systematic Review and Meta-analyses protocols.

Data sources: A bibliographic search was carried out from the following databases: EBSCOhost, Scopus, EMBASE, Virtual Health Library, PubMed, Cochrane Library, Spanish Medical Index, Spanish Bibliographic Index in Health Sciences, and Latin American and Caribbean Health Sciences Literature, from inception until September 2019.

Review methods: Studies describing the use of capnography with supraglottic airway devices during cardiopulmonary resuscitation manoeuvres were selected and evaluated using the Critical Appraisal Skills Programme.

Results: Twenty-four articles were identified by title and abstract: six were randomised clinical trials, 11 were nonrandomised clinical trials, six were descriptive prospective studies, and one was a descriptive retrospective study. Nine primary research articles were selected for synthesis. Only one provided objective values of capnography obtained with ventilation with these devices, correlating them with the results of resuscitation.

Conclusions: The evidence published so far is scarce, mostly from observational studies with high risk of bias in general. Although a degree of recommendation cannot be established, some results indicate that capnography has the potential to facilitate advanced clinical practice of ventilation with supraglottic airway devices during cardiopulmonary resuscitation.

Keywords: Capnography; Cardiopulmonary resuscitation; Heart arrest; Laryngeal masks; Supraglottic airway devices.