Systematic review and meta-analysis comparing ventilatory support in chemical, biological and radiological emergencies

Borges, Israel Baptista de Souza; Carvalho, Magali Rezende de; Quintana, Marcel de Souza; Oliveira, Alexandre Barbosa de

doi:10.1590/1518-8345.4024.3347

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Revista Latino-Americana de Enfermagem

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Review Article • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.4024.3347 copy

Systematic review and meta-analysis comparing ventilatory support in chemical, biological and radiological emergencies^* * Paper extracted from master's thesis “Efetividade de técnicas de suporte ventilatório em cenários simulados de emergências e desastres químicos, biológicos, radiológicos e nucleares: metanálise”, presented to Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask).

Method:

meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks.

Results:

in the “reduction of the time of the procedures” outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I²= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The “laryngeal mask as a guide for orotracheal intubation” subgroup showed moderate heterogeneity (I²= 74%). The “2^ndgeneration supraglottic devices” subgroup showed homogeneity (I²= 0%). All the meta-analyses favored supraglottic devices. In the “success in the first attempt” outcome, moderate homogeneity was found (I²= 52%), showing a higher proportion of correct answers for supraglottic devices.

Conclusion:

in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).

Descriptors:
Airway Management; Personal Protective Equipment; Intubation; Laryngeal Masks; Meta-Analysis; Disasters

Authors (Year)	Assessed technology	Participants (n)	Number of attempts	Technique application instrument
Ben-Abraham; Weinbroum (2004)⁽²¹21 Ben-Abraham R, Weinbroum AA. Laryngeal mask airway control versus endotracheal intubation by medical personnel wearing protective gear. Am J Emerg Med. 2004;22(1):24-6. doi: https://doi.org/10.1016/j.ajem.2003.09.006 https://doi.org/10.1016/j.ajem.2003.09.0... ⁾	1^st generation laryngeal mask; Orotracheal tube	Non-anesthetist health professional (10); Anesthetist (10)	2	Adult size Laerdal Airway Management Trainer mannequin
Castle, et al. (2009)⁽²²22 Castle N, Owen R, Hann M, Clark S, Reeves D, Gurney I. Impact of Chemical, Biological, Radiation, and Nuclear Personal Protective Equipment on the performance of low- and high-dexterity airway and vascular access skills. Resuscitation. 2009;80(11):1290-5. doi: https://doi.org/10.1016/j.resuscitation.2009.08.001 https://doi.org/10.1016/j.resuscitation.... ⁾	1^st generation laryngeal mask; Orotracheal tube	Prehospital physician (4); Resuscitation officer (6); Paramedic (14), Anesthetist (15); Emergency physician (25).	2	Adult size Laerdal Airway Management Trainer mannequin
Castle, et al. (2010)⁽²³23 Castle N, Owen R, Clarke S, Hann M, Reeves D, Gurney I. Does position of the patient adversely affect successful intubation whilst wearing CBRN-PPE? Resuscitation. 2010;81(9):1166-71. doi: https://doi.org/10.1016/j.resuscitation.2010.05.009 https://doi.org/10.1016/j.resuscitation.... ⁾	1^st generation laryngeal mask; Orotracheal tube	Pre-hospital care physician; Resuscitation officer; Paramedic; Senior and junior anesthetist; Senior and junior emergency physician (75).	2	Adult size Laerdal Airway Management Trainer mannequin
Flaishon, et al. (2004)⁽²⁴24 Flaishon R, Sotman A, Ben-Abraham R, Rudick V, Varssano D, Weinbroum AA. Antichemical protective gear prolongs time to successful airway management: a randomized, crossover study in humans. Anesthesiology. 2004;100(2):260-6. doi: 10.1097/00000542-200402000-00013 https://doi.org/10.1097/00000542-2004020... ⁾	1^st generation laryngeal mask; Orotracheal tube	Anesthetist (15)	1	Human being
Garner; Laurence; Lee (2004)⁽¹⁰10 Garner A, Laurence H, Lee A. Practicality of performing medical procedures in chemical protective ensembles. Emerg Med Australas. 2004;16(2):108-13. doi: https://doi.org/10.1111/j.1742-6723.2004.00560.x https://doi.org/10.1111/j.1742-6723.2004... ⁾	1^st generation laryngeal mask; Orotracheal tube	Paramedic (3); Emergency physician (3); Anesthetist (2)	1	Adult mannequin
Greenland, et al. (2007)⁽²⁵25 Greenland KB, Tsui D, Goodyear P, Irwin MG. Personal protection equipment for biological hazards: does it affect tracheal intubation performance? Resuscitation. 2007;74(1):119-26. doi: https://doi.org/10.1016/j.resuscitation.2006.11.011 https://doi.org/10.1016/j.resuscitation.... ⁾	ILMA^* * ILMA = Laryngeal mask capable of guiding orotracheal intubation laryngeal mask; Orotracheal tube	Senior and Junior Anesthetist (18)	1	Adult size Laerdal Airway Management Trainer mannequin
Ophir, et al.(2014)⁽²⁶26 Ophir N, Ramaty E, Rajuan-Galor I, Rosman Y, Lavon O, Shrot S, et al. Airway control in case of a mass toxicological event: superiority of second-generation supraglottic airway devices. Am J Emerg Med. 2014;32(12):1445-9. doi: https://doi.org/10.1016/j.ajem.2014.08.067 https://doi.org/10.1016/j.ajem.2014.08.0... ⁾	1^st generation laryngeal mask; 2^nd generation laryngeal mask; Laryngeal tube; Orotracheal tube	Anesthetist (20); Rescuer (26), Paramedic (27), General practitioner (24); Medical resident of different specialties (20)	3	Adult size Laerdal Airway Management Trainer mannequin
Plazikowski, et al. (2018)⁽¹⁶16 Plazikowski E, Greif R, Marschall J, Pedersen TH, Kleine-Brueggeney M, Albrecht R, et al. Emergency Airway Management in a Simulation of Highly Contagious Isolated Patients: both Isolation Strategy and Device Type Matter. Infect Control Hosp Epidemiol. 2018;39(2):145-51. doi: https://doi.org/10.1017/ice.2017.287 https://doi.org/10.1017/ice.2017.287... ⁾	i-gel laryngeal mask; ILMA^* * ILMA = Laryngeal mask capable of guiding orotracheal intubation laryngeal mask Orotracheal tube	Physician qualified as an anesthetist and emergency physician (30)	1	Adult size Laerdal Airway Management Trainer mannequin
Wang, et al.(2016)⁽²⁷27 Wang CC, Chaou CH, Tseng CY, Lin CC. The effect of personal protective equipment on emergency airway management by emergency physicians: a mannequin study. European J Emerg Med. 2016;23(2):124-9. doi: https://doi.org/10.1097/MEJ.0000000000000157 https://doi.org/10.1097/MEJ.000000000000... ⁾	1^st generation laryngeal mask; Orotracheal tube	Senior and junior emergency physician (40)	1	Adult size Laerdal Airway Management Trainer mannequin
Weaver, et al. (2015)⁽²⁸28 Weaver KR, Barr GC, Long KR, Diaz L, Ratner AS, Reboul JP, et al. Comparison of airway intubation devices when using a biohazard suit: a feasibility study. Am J Emerg Med. 2015;33(6):810-4. doi: https://doi.org/10.1016/j.ajem.2015.02.051 https://doi.org/10.1016/j.ajem.2015.02.0... ⁾	ILMA^* * ILMA = Laryngeal mask capable of guiding orotracheal intubation laryngeal mask; Orotracheal tube	Junior Emergency Physician (37)	3	Adult size Laerdal Airway Management Trainer mannequin

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[1] Corresponding author: Israel Baptista de Souza Borges. E-mail: israelbsborges@gmail.com