Effect of laryngeal mask airway versus endotracheal intubation on survival in out-of-hospital cardiac arrest: a meta-analysis of randomized controlled trials
In brief
Laryngeal mask airway shows no survival advantage over intubation in cardiac arrest
A meta-analysis of 19 randomized trials (nearly 12,000 out-of-hospital cardiac arrests) found that while the laryngeal mask airway shortens insertion time and improves first-attempt and CPR success rates, it does not change overall survival or mortality compared with endotracheal intubation. The device may be useful when rapid airway placement or limited intubation expertise is a concern, but it should not be assumed to boost patient survival.
- Journal
- Frontiers in public health (Q1)
- Published
- 17 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Dongxia Zhang, Shuang Li, Zhaofan Mo, Huazhen Xie, Yihui Lin, Quanle Liu, et al.
- PMID
- 42676471
- DOI
- 10.3389/fpubh.2026.1877439
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 6 September 2026): Meta-analysis of RCTs, airway management in OHCA
Abstract
OBJECTIVE: To compare the effectiveness and safety of laryngeal mask airway (LMA) versus endotracheal intubation (ETI) on resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA). METHODS: Randomized controlled trials (RCTs) were searched in PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM from database inception to May 31, 2025. The methodological quality and risk of bias of the included RCTs were evaluated with the Cochrane ROB2 tool. We employed RevMan 5.3 and TSA software for all statistical analyses, including meta-analysis, sensitivity analysis, and trial sequential analysis (TSA). The certainty of the evidence was graded according to the GRADE approach. The primary outcomes included airway establishment time and CPR success rate, and the secondary outcomes included first-attempt intubation success rate, mortality, survival rate, left ventricular ejection fraction, and adverse events. RESULTS: Nineteen RCTs (11,982 patients) were included. Compared with ETI, LMA was associated with a significantly shorter airway establishment time (MD: -86.95 s; 95% CI: -103.00, -70.90; p < 0.00001), higher first-attempt success rate (RR: 1.44; 95% CI: 1.32, 1.58; p < 0.00001), improved CPR success rate (RR: 1.44; 95% CI: 1.25, 1.67; p < 0.00001), and LVEF (SMD: 1.57; 95% CI: 0.65, 2.48; p < 0.00001). No significant differences were observed in survival rate (RR: 0.98; 95% CI: 0.88, 1.09; p = 0.69), nor mortality (RR: 1.00; 95% CI: 0.99, 1.01; p = 0.69). LMA was associated with a lower rate of vocal cord injury (RR: 0.11; 95% CI: 0.03, 0.47; p = 0.003), although this finding is based on a small number of events and should be interpreted cautiously. The quality of the GRADE evidence ranged from very low to high. CONCLUSION: Compared with ETI, LMA demonstrates significantly higher operational efficiency and a favorable safety profile in the management of OHCA. However, given that survival and mortality outcomes are comparable between the two strategies, LMA may be considered a reasonable alternative to ETI, particularly when minimizing interruptions in chest compressions is a priority or when ETI expertise is limited. The choice of airway device should be individualized rather than uniformly prioritized. In summary, LMA may offer procedural advantages and fewer airway-related complications, while evidence for a survival benefit remains insufficient. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42025645299, identifier (CRD42025645299).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.