Evidence map›Paper›PMID 34126133›Full record

Trial reportResuscitation2021

Cost-effectiveness of the i-gel supraglottic airway device compared to tracheal intubation during out-of-hospital cardiac arrest: Findings from the AIRWAYS-2 randomised controlled trial.

Elizabeth A Stokes, Michelle J Lazaroo, Madeleine Clout, Stephen J Brett, Sarah Black, Kim Kirby, Jerry P Nolan, Barnaby C Reeves, Maria Robinson, Chris A Rogers and 8 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Resuscitation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.9field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 9 citations in OpenAlex.

  1. Review
  2. Article
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 7 institutions in 1 country.

Elizabeth A StokesHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK.
Michelle J LazarooClinical Trials and Evaluation Unit (CTEU), Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
Madeleine CloutClinical Trials and Evaluation Unit (CTEU), Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
Stephen J BrettDepartment of Surgery and Cancer, Imperial College London, London, UK.
Sarah BlackSouth Western Ambulance Service NHS Foundation Trust, Exeter, UK.
Kim KirbySouth Western Ambulance Service NHS Foundation Trust, Exeter, UK; University of the West of England, Glenside Campus, Bristol, UK.
Jerry P NolanBristol Medical School, University of Bristol, Bristol, UK; Department of Anaesthesia, Royal United Hospital, Bath, UK.
Barnaby C ReevesClinical Trials and Evaluation Unit (CTEU), Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
Maria RobinsonSouth Western Ambulance Service NHS Foundation Trust, Exeter, UK.
Chris A RogersClinical Trials and Evaluation Unit (CTEU), Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
Lauren J ScottClinical Trials and Evaluation Unit (CTEU), Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Helena SmarttClinical Trials and Evaluation Unit (CTEU), Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
Adrian SouthSouth Western Ambulance Service NHS Foundation Trust, Exeter, UK.
Jodi TaylorClinical Trials and Evaluation Unit (CTEU), Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Medical School, University of Bristol, Bristol, UK.
Matthew ThomasIntensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Sarah VossUniversity of the West of England, Glenside Campus, Bristol, UK.
Jonathan R BengerUniversity of the West of England, Glenside Campus, Bristol, UK.
Sarah WordsworthHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK. Electronic address: sarah.wordsworth@dph.ox.ac.uk.
At Bristol · GBSouth Western Ambulance Service NHS Foundation Trust · GBUniversity of the West of England · GBUniversity Hospitals Bristol NHS Foundation Trust · GBUniversity of Oxford · GBImperial College London · GBRoyal United Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimOptimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial cost-effectiveness analysis.

methodsA within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a six-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes.

results9296 eligible patients were attended by 1382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to six months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI -0.0059 to 0.0028). Total costs per participant up to six months post-OHCA were £3570 and £3413 in the i-gel and TI groups respectively (mean difference £157, 95% CI -£270 to £583). Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results.

conclusionThe small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA.

Indexed as

Cardiopulmonary ResuscitationEmergency Medical ServicesOut-of-Hospital Cardiac ArrestAdultCost-Benefit AnalysisHumansIntubation, IntratrachealState MedicineAirway managementCost-effectiveness analysisOut of hospital cardiac arrest

Identifiers

PMID34126133
PMCPMC8525511
OpenAlexW3167270234

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.