Clinical scenario A two year old has a witnessed cardiopulmonary arrest whilst in your Emergency Department. You are able to ventilate the child using a bag valve mask (BVM) and oral pharyngeal airway, but notice his stomach is becoming inflated. In cardiac arrest in adults you know that a LMA or iGel is now the advised airway to use (ALS guidelines 2011), but you wonder if this could apply to children as well.

Search parameters MEDLINE (1950-present) and EMBASE (1980 to present) [(exp ventilation) AND (exp ped* OR paed* OR child) AND (exp arrest)] LIMIT: English.

Search outcomes 327 papers, 6 of which were relevant. A further two papers were found from the reference of one of the original search articles.

Comments No paper looks specifically at using a SAD in a paediatric arrest, all the cases have been in mannequins or in anaesthetised children, simulating arrest. Hypoxia, which is often the cause, is a very important factor to overcome in paediatric arrest. By using a SAD one can undertake uninterrupted chest compressions and ventilation. The comparison with BVM and intubation in the prehospital setting shows that neurological outcome/survival is not significantly different between the two groups. Using a SAD may not be worth doing as it takes time to insert, meaning there is no ventilation in that time. However, in children with difficult airways who intubation poses a problem, it is worth bearing in mind the use of a SAD. Over time the effectiveness of BVM decreases, hence a more definitive airway should always be planned.

Clinical bottom line A bag valve mask with oropharyngeal airway should be used initially to oxygenate and ventilate a child in cardiopulmonary arrest. A supraglottic airway should be considered in children with a difficult airway or if there is going to be delay in establishing a definitive airway (endotracheal intubation).

SAD – supraglottic airway device. LMA – laryngeal mask airway. OPA – oropharyngeal airway. BVM – bag-valve-mask. ALS – advanced life support.