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

open access

Page views 162
Article views/downloads 87
Get Citation

Connect on Social Media

Connect on Social Media

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.

Abstract

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.

Article available in PDF format

View PDF Download PDF file

References

  1. Smereka J, Szarpak L, Filipiak K. Modern medicine in COVID-19 era. Disaster Emerg Med J. 2020; 5(2): 103–105.
  2. Ruetzler K, Szarpak L, Filipiak K, et al. The COVID-19 pandemic — a view of the current state of the problem. Disaster Emerg Med J. 2020; 5(2): 106–107.
  3. Głowacka Z, Ryszka P, Wydeheft L, et al. COVID-19 occurrence and symptoms depending on vaccination status: a retrospective single-centre analysis of 27,209 patients. Med Res J. 2023; 8(4): 286–291.
  4. Krawczyk A, Szarpak L, Bragazzi N, et al. Effect of SARS-CoV-2 infection on out-of-hospital cardiac arrest outcomes — systematic review and meta-analysis. Ann Agric Environ Med. 2023; 30(2): 369–375.
  5. Bielski K, Pruc M, Rafique Z, et al. Uncovering the effects of COVID-19 on in-hospital cardiac arrest — a living systematic review and meta-analysis. Ann Agric Environ Med. 2023; 30(3): 498–504.
  6. Baldi E, Sechi GM, Mare C, et al. Lombardia CARe researchers. COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. Eur Heart J. 2020; 41(32): 3045–3054.
  7. Rogaczewski P, Cyls D, Kasprzak M, et al. The impact of the COVID-19 pandemic on hospital functioning and mortality among non-COVID-19 patients. Med Res J. 2022; 7(4): 314–320.
  8. Szarpak L, Borkowska M, Peacock FW, et al. Characteristics and outcomes of in-hospital cardiac arrest in COVID-19. A systematic review and meta-analysis. Cardiol J. 2021; 28(4): 503–508.
  9. Bielski K, Makowska K, Makowski A, et al. Impact of COVID-19 on in-hospital cardiac arrest outcomes: An updated meta-analysis. Cardiol J. 2021; 28(6): 816–824.
  10. Tran K, Cimon K, Severn M, et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012; 7(4): e35797.
  11. Smereka J, Szarpak L. The use of personal protective equipment in the COVID-19 pandemic era. Am J Emerg Med. 2020; 38(7): 1529–1530.
  12. Malysz M, Jaguszewski M, Szarpak L, et al. Comparison of different chest compression positions for use while wearing CBRN-PPE: a randomized crossover simulation trial. Disaster Emerg Med J. 2020; 5(3): 127–133.
  13. Smereka J, Szarpak L. COVID 19 a challenge for emergency medicine and every health care professional. Am J Emerg Med. 2020; 38(10): 2232–2233.
  14. Szarpak L, Peacock FW, Rafique Z, et al. Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med. 2022; 53: 122–126.
  15. Ludwin K, Bialka S, Czyzewski L, et al. Video laryngoscopy for endotracheal intubation of adult patients with suspected/ confirmed COVID-19. A systematic review and meta-analysis of randomized controlled trials. Disaster Emerg Med J. 2020; 5(2): 85–97.
  16. Drozd A, Smereka J, Filipiak KJ, et al. Intraosseous versus intravenous access while wearing personal protective equipment: a meta-analysis in the era of COVID-19. Kardiol Pol. 2021; 79(3): 277–286.
  17. Smereka J, Szarpak L, Filipiak KJ, et al. Which intravascular access should we use in patients with suspected/confirmed COVID-19? Resuscitation. 2020; 151: 8–9.
  18. Edelson DP, Sasson C, Chan PS, et al. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19: from the emergency cardiovascular care committee and get with the guidelines-resuscitation adult and pediatric task forces of the american heart association. Circulation. 2020; 141(25): e933–e943.
  19. Szarpak L, Drozd A, Smereka J. Airway management and ventilation principles in COVID-19 patients. J Clin Anesth. 2020; 65: 109877.
  20. Benger JR, Kirby K, Black S, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial. JAMA. 2018; 320(8): 779–791.
  21. Wang HE, Schmicker RH, Daya MR, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial. JAMA. 2018; 320(8): 769–778.
  22. Perkins GD, Morley PT, Nolan JP, et al. International Liaison Committee on Resuscitation: COVID-19 consensus on science, treatment recommendations and task force insights. Resuscitation. 2020; 151: 145–147.
  23. Nolan JP, Monsieurs KG, Bossaert L, et al. European Resuscitation Council COVID-Guideline Writing Groups. European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation. 2020; 153: 45–55.
  24. Page M, McKenzie J, Bossuyt P, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021: 372:n71.
  25. Phelps R, Dumas F, Maynard C, et al. Cerebral performance category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013; 41(5): 1252–1257.
  26. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9): 603–605.
  27. Norris JM, Simpson BS, Ball R, et al. A modified Newcastle-Ottawa scale for assessment of study quality in genetic urological research. Eur Urol. 2021; 79(3): 325–326.
  28. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: 13.
  29. Higgins JPT, Altman DG, Gøtzsche PC, et al. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928.
  30. Armour R, Ghamarian E, Helmer J, et al. Impact of the COVID-19 pandemic on canadian emergency medical system management of out-of-hospital cardiac arrest: a retrospective cohort study. Resuscitation. 2023 [Epub ahead of print]: 110054.
  31. Fan CY, Sung CW, Chen CY, et al. Updated trends in the outcomes of out-of-hospital cardiac arrest from 2017-2021: Prior to and during the coronavirus disease (COVID-19) pandemic. J Am Coll Emerg Physicians Open. 2023; 4(6): e13070.
  32. Glober NK, Supples M, Faris G, et al. Out-of-hospital cardiac arrest volumes and characteristics during the COVID-19 pandemic. Am J Emerg Med. 2021; 48: 191–197.
  33. Hosomi S, Zha L, Kiyohara K, et al. Survival following an out-of-hospital cardiac arrest in Japan in 2020 versus 2019 according to the cause. Acute Med Surg. 2022; 9(1): e777.
  34. Huabbangyang T, Klaiangthong R, Silakoon A, et al. The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study. Int J Emerg Med. 2023; 16(1): 9.
  35. Kennedy C, Alqudah Z, Stub D, et al. The effect of the COVID-19 pandemic on the incidence and survival outcomes of EMS-witnessed out-of-hospital cardiac arrest. Resuscitation. 2023; 187: 109770.
  36. Kim YSu, Lee SH, Lim HJ, et al. Impact of COVID-19 on out-of-hospital cardiac arrest in Korea. J Korean Med Sci. 2023; 38(12): e92.
  37. Lai PH, Lancet EA, Weiden MD, et al. Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City. JAMA Cardiol. 2020; 5(10): 1154–1163.
  38. Liu CH, Tsai MJ, Hsu CF, et al. The influence of the COVID-19 pandemic on emergency medical services to out-of-hospital cardiac arrests in a low-incidence urban city: an observational epidemiological analysis. Int J Environ Res Public Health. 2023; 20(3).
  39. Navalpotro-Pascual JM, Fernández Pérez C, Peinado Vallejo FA, et al. Caseload and cardiopulmonary arrest management by an out-of-hospital emergency service during the COVID-19 pandemic. Emergencias. 2021; 33(2): 100–106.
  40. Navalpotro-Pascual JM, Martín DM, León MJG, et al. Impact of different waves of COVID-19 on emergency medical services and out-of-hospital cardiopulmonary arrest in Madrid, Spain. World J Emerg Med. 2022; 13(5): 386–389.
  41. Rosell Ortiz F, Fernández Del Valle P, Knox EC, et al. OHSCAR investigators. Influence of the Covid-19 pandemic on out-of-hospital cardiac arrest. A Spanish nationwide prospective cohort study. Resuscitation. 2020; 157: 230–240.
  42. Riyapan S, Chantanakomes J, Roongsaenthong P, et al. Impact of the COVID-19 outbreak on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand. Int J Emerg Med. 2022; 15(1): 26.
  43. Sugiyama J, Inoue S, Inada M, et al. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the operational efficiency of emergency medical services and its association with out-of-hospital cardiac arrest survival rates: A population-based cohort study in Kobe, Japan. Acute Med Surg. 2023; 10(1): e00865.
  44. Yu JH, Liu CY, Chen WK, et al. Impact of the COVID-19 pandemic on emergency medical service response to out-of-hospital cardiac arrests in Taiwan: a retrospective observational study. Emerg Med J. 2021; 38(9): 679–684.
  45. Jarvis JL, Wampler D, Wang HE. Association of patient age with first pass success in out-of-hospital advanced airway management. Resuscitation. 2019; 141: 136–143.
  46. Lee AF, Chien YC, Lee BC, et al. Effect of placement of a supraglottic airway device vs endotracheal intubation on return of spontaneous circulation in adults with out-of-hospital cardiac arrest in Taipei, Taiwan: a cluster randomized clinical trial. JAMA Netw Open. 2022; 5(2): e2148871.
  47. Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth. 1995; 42(11): 1017–1023.
  48. Hsu A, Sasson C, Kudenchuk P, et al. 2021 interim guidance to health care providers for basic and advanced cardiac life support in adults, children, and neonates with suspected or confirmed COVID-19. Circ Cardiovasc Qual Outcomes. 2021; 14(10): e008396.
  49. Bielski K, Szarpak A, Jaguszewski MJ, et al. The influence of COVID-19 on out-hospital cardiac arrest survival outcomes: an updated systematic review and meta-analysis. J Clin Med. 2021; 10(23): 5573.
  50. Stokes EA, Lazaroo MJ, Clout M, et al. 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. Resuscitation. 2021; 167: 1–9.