Airway management with a supraglottic airway device during resuscitation by basic life support providers: a systematic review.

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.