open access

Vol 5, No 2 (2020)
Research paper
Published online: 2020-05-21
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Video laryngoscopy for endotracheal intubation of adult patients with suspected/ confirmed COVID-19. A systematic review and meta-analysis of randomized controlled trials

Kobi Ludwin, Szymon Bialka, Lukasz Czyzewski, Jacek Smereka, Marek Dabrowski, Agata Dabrowska, Jerzy Robert Ladny, Kurt Ruetzler, Lukasz Szarpak
DOI: 10.5603/DEMJ.a2020.0023
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Disaster Emerg Med J 2020;5(2):85-97.

open access

Vol 5, No 2 (2020)
ORIGINAL ARTICLES
Published online: 2020-05-21

Abstract

Study objective: During a pandemic, medical personnel while in contact with patients with suspected/confirmed COVID-19 should wear full personal protective equipment (PPE) for aerosol-generating procedures to reduce the risk of infection. Most studies of intubation in level C PPE conditions have been relatively small. Our aim is to quantify the available data on success rates in order to provide an evidence-based benchmark to gauge performance in the published literature.

Methods: A structured literature search was performed with PubMed, Scopus, Embase, Web of Science, and Cochrane databases. The electronic database search was supplemented by searching Google Scholar and by back-searching the reference lists of identified studies for suitable articles. Data were evaluated and extracted by two independent reviewers on the basis of qualitative and quantitative variables of interest. Q statistic and I2 statistics were used to assess the heterogeneity between the studies.

Results : Fifteen randomized controlled trials were included. The use of PPE during intubation as compared with intubation without PPE reduced intubation efficacy (90.0% vs. 97.9%; RR = 0.94; 95%CI: 0.90–0.99; p < 0.001) and increased the procedure time (MD = 7.73; 95%CI: 4.98–10.47; p < 0.001). Direct laryngoscopy compared with video laryngoscopes offered similar intubation success rate (93.6% vs. 92.3%; RR = 0.99; 95%CI: 0.97–1.02; p = 0.66) and shorter intubation time (MD = 63; 95%CI: -0.77–12.03; p = 0.08). However, subgroup analysis showed that intubation with Macintosh blade video laryngoscopes was more effective than that with direct laryngoscopes (98.1% vs. 96.4%; RR = 1.00; 95%CI: 0.97–1.03; p = 0.90).

Conclusions: Our meta-analysis suggests that PPE reduces the effectiveness of endotracheal intubation. The use of direct laryngoscopy for intubating patients with suspected/confirmed COVID-19 by an intubator wearing level C PPE is associated with overall intubation time reduction and an increase in intubation success rate compared with video laryngoscopes. However, the findings suggest that Macintosh blade video laryngoscopes during endotracheal intubation with PPE may be an alternative to direct laryngoscopes. Video laryngoscopy can be helpful for less experienced personnel.

Abstract

Study objective: During a pandemic, medical personnel while in contact with patients with suspected/confirmed COVID-19 should wear full personal protective equipment (PPE) for aerosol-generating procedures to reduce the risk of infection. Most studies of intubation in level C PPE conditions have been relatively small. Our aim is to quantify the available data on success rates in order to provide an evidence-based benchmark to gauge performance in the published literature.

Methods: A structured literature search was performed with PubMed, Scopus, Embase, Web of Science, and Cochrane databases. The electronic database search was supplemented by searching Google Scholar and by back-searching the reference lists of identified studies for suitable articles. Data were evaluated and extracted by two independent reviewers on the basis of qualitative and quantitative variables of interest. Q statistic and I2 statistics were used to assess the heterogeneity between the studies.

Results : Fifteen randomized controlled trials were included. The use of PPE during intubation as compared with intubation without PPE reduced intubation efficacy (90.0% vs. 97.9%; RR = 0.94; 95%CI: 0.90–0.99; p < 0.001) and increased the procedure time (MD = 7.73; 95%CI: 4.98–10.47; p < 0.001). Direct laryngoscopy compared with video laryngoscopes offered similar intubation success rate (93.6% vs. 92.3%; RR = 0.99; 95%CI: 0.97–1.02; p = 0.66) and shorter intubation time (MD = 63; 95%CI: -0.77–12.03; p = 0.08). However, subgroup analysis showed that intubation with Macintosh blade video laryngoscopes was more effective than that with direct laryngoscopes (98.1% vs. 96.4%; RR = 1.00; 95%CI: 0.97–1.03; p = 0.90).

Conclusions: Our meta-analysis suggests that PPE reduces the effectiveness of endotracheal intubation. The use of direct laryngoscopy for intubating patients with suspected/confirmed COVID-19 by an intubator wearing level C PPE is associated with overall intubation time reduction and an increase in intubation success rate compared with video laryngoscopes. However, the findings suggest that Macintosh blade video laryngoscopes during endotracheal intubation with PPE may be an alternative to direct laryngoscopes. Video laryngoscopy can be helpful for less experienced personnel.

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Keywords

endotracheal intubation, laryngoscope, infected patient, COVID-19, personal protective equipment, meta-analysis

About this article
Title

Video laryngoscopy for endotracheal intubation of adult patients with suspected/ confirmed COVID-19. A systematic review and meta-analysis of randomized controlled trials

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 5, No 2 (2020)

Article type

Research paper

Pages

85-97

Published online

2020-05-21

DOI

10.5603/DEMJ.a2020.0023

Bibliographic record

Disaster Emerg Med J 2020;5(2):85-97.

Keywords

endotracheal intubation
laryngoscope
infected patient
COVID-19
personal protective equipment
meta-analysis

Authors

Kobi Ludwin
Szymon Bialka
Lukasz Czyzewski
Jacek Smereka
Marek Dabrowski
Agata Dabrowska
Jerzy Robert Ladny
Kurt Ruetzler
Lukasz Szarpak

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