Vol 9, No 1 (2024)
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Published online: 2024-02-15

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The impact of the COVID-19 pandemic on airway management with supraglottic airway devices among out-of-hospital cardiac arrests: a systematic review and meta-analysis

Miroslaw Dabkowski1, Karol Bielski2, Michal Pruc12, Dawid Kacprzyk1, Nicola Luigi Bragazzi3, Katarzyna Jaroszuk4, Aldona Kubica5, Damian Świeczkowski6, Malgorzata Kietlinska7, Lukasz Szarpak789
Medical Research Journal 2024;9(1):82-89.


Introduction: The COVID-19 pandemic has led to increased cases of out-of-hospital cardiac arrest (OHCA),
impacting emergency medical services and necessitating changes in resuscitation protocols to protect
healthcare workers from virus transmission. Amidst these challenges, there’s a shift in prehospital airway
management techniques, with a renewed focus on endotracheal intubation over supraglottic airway devices
for better protection against aerosol spread during cardiopulmonary resuscitation. This systematic
review and meta-analysis aimed to examine the influence of the COVID-19 pandemic on the use of SGA
as a method of securing the airway during out-of-hospital cardiac arrest.

Material and methods: PubMed Central, Scopus, EMBASE, and the Cochrane Library databases were
systematically searched. English-language literature was searched up to December 5th, 2023. This search
was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
statement. Fixed and random effects models were used to undertake the meta-analysis when appropriate.
The risk of bias was assessed through the Newcastle-Ottawa Scale.

Results: Fifteen studies met the inclusion criteria for the meta-analysis. Pooled analysis showed that
SGAs were chosen as the method of airway protection in 46.3% and 49.8% of cases, pre- vs. during the
COVID-19 pandemic (OR = 0.76; 95%CI: 0.65 to 0.90; p = 0.001). In the case of endotracheal intubation,
statistically significant differences were also observed in the frequency of use during OHCA in the
pre-pandemic period vs. during the COVID-19 pandemic period (19.0% vs. 14.2%, respectively; OR =
1.66; 95%CI: 1.20 to 2.28; p = 0.002).

Conclusions: The study’s conclusions indicate a significant increase in the use of supraglottic airway devices
during the COVID-19 pandemic for out-of-hospital cardiac arrests. Additionally, a decrease in the use of
endotracheal intubation was observed. Effective airway management correlates with better outcomes after
cardiac arrests, although the specific impact of these techniques during the pandemic remains unclear.

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