Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies

Borges, Israel Baptista de Souza; Carvalho, Magali Rezende de; Quintana, Marcel de Souza; Lima, Dalmo Valério Machado de; Barbosa, Bruno Leal; Oliveira, Alexandre Barbosa de

doi:10.1590/0034-7167-2020-0313

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Brasil

Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (05) • 2021 • https://doi.org/10.1590/0034-7167-2020-0313 copy

Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies

Tubo orotraqueal versus dispositivos supraglóticos en desastres biológicos, químicos y radiológicos: metaanálisis en estudios de maniquíes

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting.

Methods:

Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals.

Results:

Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I² = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I² = 75%. Another analysis was made by reproductive methodology subgroups. Ophir’s subgroup: -15.70 [-17.04; -14.37]; I² = 0%. All meta-analyses had orotracheal tube as comparator.

Conclusion:

Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.

Descriptors:
Meta-Analysis; Personal Protective Equipment; Laryngeal Masks; Disasters; Manikins

Authors (Year)	Device	Participants (number)	Success assessment method	Time limit (seconds)
Ben-Abraham; Weinbroum⁽²²22 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. https://doi.org/10.1016/j.ajem.2003.09.006 https://doi.org/10.1016/j.ajem.2003.09.0... ⁾ (2004)	Laryngeal Mask not specified; Orotracheal tube	Healthcare provider non-anesthetist (10); Anesthetist (10)	Expansion of the mannequin's lung	30
Castle et al⁽²³23 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. https://doi.org/10.1016/j.resuscitation.2009.08.001 https://doi.org/10.1016/j.resuscitation.... ⁾ (2009)	Laryngeal Mask not specified; Orotracheal tube	Pre-hospital care doctors (4); Resuscitation officers (6); Paramedics (14); Anesthetists (15); Emergency physicians (25).	Capnography	150
Castle et al (1)⁽²⁴24 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. https://doi.org/10.1016/j.resuscitation.2010.05.009 https://doi.org/10.1016/j.resuscitation.... ⁾ (2010)	Laryngeal Mask not specified; Orotracheal tube	Anesthetist consultants (5); Anesthetist trainee (10); Emergency physician consultant (8); Emergency physician trainee (17); Prehospital care doctor (4); Paramedic (17); Resuscitation officer (6)	Capnography	Not reported
Garner; Laurence; Lee⁽⁹9 Garner A, Laurence H, Lee A. Practicality of performing medical procedures in chemical protective ensembles. Emerg Med Australas. 2004;16(2):108-13. https://doi.org/10.1111/j.1742-6723.2004.00560.x https://doi.org/10.1111/j.1742-6723.2004... ⁾ (2004)	Laryngeal Mask not specified; Orotracheal tube	Paramedics (3); Emergency physicians (3); Anesthetists (2).	Expansion of the mannequin's lung	Not reported
Greenland et al⁽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. https://doi.org/10.1016/j.resuscitation.2006.11.011 https://doi.org/10.1016/j.resuscitation.... ⁾ (2007)	Intubating Laryngeal Mask; Orotracheal tube	Consultant anesthetists (04); Anesthetist trainees (14)	Expansion of the mannequin's lung	Not reported
Ophir et al⁽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. https://doi.org/10.1016/j.ajem.2014.08.067 https://doi.org/10.1016/j.ajem.2014.08.0... ⁾ (2014)	Laryngeal Mask Unique; Laryngeal Mask Supreme; Laryngeal tube Suction - Disposal; Orotracheal tube	Anesthetist (20); Medic (26), Paramedic (27), General practitioners (24); Residents (20)	Expansion of the mannequin's lung	Not reported
Plazikowski et al⁽¹⁵15 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. https://doi.org/10.1017/ice.2017.287 https://doi.org/10.1017/ice.2017.287... ⁾ (2018)	i-gel; Intubating Laryngeal Mask; Orotracheal tube	Physician qualified as anesthetist and emergencist (30)	Expansion of the mannequin's lung	240
Wang et al⁽¹⁶16 Wang CC, Chaou CH, Tseng CY, Lin CC. The effect of personal protective equipment on emergency airway management by emergency physicians: a mannequin study. Eur J Emerg Med. 2016;23(2):124‐9. https://doi.org/10.1097/MEJ.0000000000000157 https://doi.org/10.1097/MEJ.000000000000... ⁾ (2016)	Laryngeal Mask not specified; Orotracheal tube	Emergency physician consultant and trainee (40)	Expansion of the mannequin's lung	Not reported
Weaver et al⁽²⁷27 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. https://doi.org/10.1016/j.ajem.2015.02.051 https://doi.org/10.1016/j.ajem.2015.02.0... ⁾ (2015)	Intubating Laryngeal Mask; Orotracheal tube	Emergency physician trainee (37)	Expansion of the mannequin's lung	Not reported

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