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
2020 Disaster and Emergency Medicine Journal  
INTRODUCTION: 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. MATERIAL AND METHODS: A
more » ... AL AND 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 I 2 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
doi:10.5603/demj.a2020.0023 fatcat:snbaqk27ojewvh3iq4op5ik3yu