Airway management with a supraglottic airway device during resuscitation by basic life support providers: a systematic review
Year: 2026
Type: review
Study design: Systematic Review
Abstract: BACKGROUND: Delivering effective ventilation during cardiopulmonary resuscitation is challenging. There is growing interest among Basic Life Support (BLS) providers in using supraglottic airways devices (SGAs). This systematic review, conducted for the International Liaison Committee on Resuscitation, evaluated whether SGA use compared with bag-valve-mask (BVM) ventilation by BLS providers during adult in-hospital or out-of-hospital cardiac arrest improves clinical outcomes. METHODS: The review was registered with PROSPERO (CRD42024592988). Medline, EMBASE, and Cochrane databases were searched from inception to October 20, 2025. Risk of bias was assessed using RoB 2.0 and ROBINS-I, and certainty of evidence was rated using GRADE. Narrative synthesis followed Synthesis without meta-analysis guidelines. Meta-analysis was not feasible for observational studies due to substantial heterogeneity. RESULTS: Of 11,310 records screened, 16 studies met inclusion criteria (3 randomised trials, 13 observational studies) evaluating use with BLS-trained providers. No studies involved first rescuers (e.g. lifeguards) or first responders, (e.g. firefighters, police). Randomised trials showed, with low certainty of evidence, no significant difference in survival to hospital discharge or 30 days between SGA and BVM ventilation (RR 1.28; 95% CI 0.46-3.55). Observational studies provided very low-certainty evidence for neurological outcomes, survival at discharge or 30 days, and return of spontaneous circulation, with inconsistent findings and no clear benefit of SGA use. One randomised trial suggested a higher chest compression fraction with SGAs. Emesis rates were similar in randomised trials. CONCLUSION: A review of current evidence reported no evidence of benefit of SGA compared with BVM use by BLS-trained providers. Considerable heterogeneity was observed among the studies, and it was not possible to compare outcomes between SGA type. Data are lacking for first rescuers and first responders.
Source: Resuscitation
Authors: Guillaume Debaty, Nicholas J. Johnson, Gavin Perkins, Vihara Dassanayake, Lucas Snow, Nicolas Segond, Laurie J. Morrison, Janet E. Bray, Michael Smyth, Theresa Olasveengen, Rebecca Cash, Julie Considine, Sung Phil Chung, Katie Dainty, Bridget Dicker, Fredrik Folke, Anthony Lagina, George Lucas, Carolina Malta Hansen, Takanari Ikeyama, Siobhan Masterson, Ziad Nehme, Tatsuya Norii, Violetta Raffary, Giuseppe Ristagno, Aloka Samantaray, Baljit Singh, Christopher M. Smith, Anastasia Spartinou, Christian Vaillancourt, Federico Semeraro, Peter Morley
Institutions: Institut polytechnique de Grenoble, Centre National de la Recherche Scientifique, Translational Innovation in Medicine and Complexity, Université Grenoble Alpes, University of Washington, University Hospitals Birmingham NHS Foundation Trust, University of Toronto, University of Warwick, Heartlands Hospital, National Hospital of Sri Lanka, University of Colombo, Sunnybrook Health Science Centre, Curtin University, Monash University, Centre Hospitalier Universitaire de Grenoble
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,490
OpenAlex ID: W7162444513