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Meta-Analyses

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Endotracheal intubation during chest compressions in the pediatric simulation setting: a systematic review and meta-analysis

  • Filippo Sanfilippo1,*,†,
  • Simone Messina2,†
  • Federica Merola1,†
  • Stefano Tigano1
  • Alberto Morgana2
  • Arnaldo Dimagli3
  • Luigi La Via1
  • Marinella Astuto1

1Department of Anesthesiology and Intensive Care, AOU ``Policlinico-San Marco'', 95123 Catania, Italy

2Department of Medical and Surgical Sciences, ``Magna Graecia'' University, 88100 Catanzaro, Italy

3Bristol Heart Institute, University of Bristol, BS2 8ED Bristol, United Kingdom

DOI: 10.22514/sv.2022.034

Submitted: 03 February 2022 Accepted: 15 March 2022

Online publish date: 09 May 2022

*Corresponding Author(s): Filippo Sanfilippo E-mail: filipposanfi@yahoo.it

† These authors contributed equally.

Abstract

Endotracheal intubation (ETI) in the pediatric setting is a complex skill and performing ETI during pediatric cardiopulmonary resuscitation is even more challenging. Simulation studies have investigated the performances of several devices for ETI. We undertook a systematic review and meta-analysis to evaluate the performances of devices for ETI during simulated pediatric on-going chest compressions. Devices were divided in four groups: direct laryngoscopy (DL) with Macintosh or Miller blade, or video-laryngoscopy with screen-on-device (VLS-SoD) or with distant monitor (VLS-DM). Primary outcomes were overall success rate (SR) and time-to-intubation (TTI). Results are expressed as Risk Ratio (RR) or Mean Difference (MD) with 95% confidence interval. We included 12 studies comparing at least two devices. The SR was greater for VLS as compared to DL-Miller (RR: 0.83 (0.78; 0.89), p < 0.00001) or DL-Macintosh (RR: 0.81 (0.77; 0.85), p < 0.00001). Subgroup analyses confirmed that both types of VLS were superior to DL-Miller (VLS-DM: p = 0.03; VLS-SoD: p < 0.00001) or DL-Macintosh (both VLSs: p < 0.00001). As compared with VLS, TTI was longer with both DL blades: Miller (MD: 8.26 seconds (5.30; 11.21), p < 0.00001) or Macintosh blade (MD: 7.63 seconds (4.14; 11.12), p < 0.00001). In the subgroup analyses, VLS-SoD was superior to DL-Miller or DL-Macintosh (both p < 0.00001), while VLS-DM was superior to DL-Macintosh (p < 0.00001), possibly not to DL-Miller (p = 0.06). Under simulated conditions of ongoing pediatric resuscitation, use of VLS guarantees higher overall SR and shorter TTI as compared to DL performed with Miller or Macintosh blade. Among VLSs, those with screen-on-device may have better performances that those with distant monitor.


Keywords

Direct laryngoscopy; Video-laryngoscopy; Manikin; Orotracheal intubation; Children


Cite and Share

Filippo Sanfilippo,Simone Messina,Federica Merola,Stefano Tigano,Alberto Morgana,Arnaldo Dimagli,Luigi La Via,Marinella Astuto. Endotracheal intubation during chest compressions in the pediatric simulation setting: a systematic review and meta-analysis. Signa Vitae. 2022.doi:10.22514/sv.2022.034.

References

[1] Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, Warden CR, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children. Circulation. 2009; 119: 1484–1491.

[2] Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circulation: Cardiovascular Quality and Outcomes. 2019; 12: e005580.

[3] Knudson JD, Neish SR, Cabrera AG, Lowry AW, Shamszad P, Morales DLS, et al. Prevalence and outcomes of pediatric in-hospital cardiopul-monary resuscitation in the United States. Critical Care Medicine. 2012; 40: 2940–2944.

[4] Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020; 141: e139–e596.

[5] American Heart Association. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support. Pediatrics. 2006; 117: e989–1004.

[6] Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European resuscitation council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021; 161: 152–219.

[7] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339: b2700–b2700.

[8] Wells G, Shea B, O’Connell D, Robertson J, Peterson J, Welch V, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 2000. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm (Accessed: 12 August 2021).

[9] Higgins JP, Ramsay C, Reeves BC, Deeks JJ, Shea B, Valentine JC, et al. Issues relating to study design and risk of bias when including non‐randomized studies in systematic reviews on the effects of interventions. Research Synthesis Methods. 2013; 4: 12–25.

[10] Schünemann HJ, Tugwell P, Reeves BC, Akl EA, Santesso N, Spencer FA, et al. Non-randomized studies as a source of complementary, sequential or replacement evidence for randomized controlled trials in systematic reviews on the effects of interventions. Research Synthesis Methods. 2013; 4: 49–62.

[11] Higgins JPT. Measuring inconsistency in meta-analyses. British Medical Journal. 2003; 327: 557–560.

[12] Tampo A, Suzuki A, Sako S, Kunisawa T, Iwasaki H, Fujita S. A comparison of the Pentax Airway Scope™ with the Airtraq™ in an infant manikin. Anaesthesia. 2012; 67: 881–884.

[13] Claret P, Asencio R, Rogier D, Roger C, Fournier P, Tran T, et al. Comparison of Miller and Airtraq laryngoscopes for orotracheal intuba-tion by physicians wearing CBRN protective equipment during infant resuscitation: a randomized crossover simulation study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2016; 24: 35.

[14] Szarpak L, Truszewski Z, Czyzewski L, Kurowski A, Bogdanski L, Zasko P. Child endotracheal intubation with a Clarus Levitan fiberoptic stylet vs. Macintosh laryngoscope during resuscitation performed by paramedics: a randomized crossover manikin trial. The American Journal of Emergency Medicine. 2015; 33: 1547–1551.

[15] Szarpak L, Kurowski A, Czyzewski L, Rodríguez-Núñez A. Video rigid flexing laryngoscope (RIFL) vs. Miller laryngoscope for tracheal intubation during pediatric resuscitation by paramedics: a simulation study. The American Journal of Emergency Medicine. 2015; 33: 1019–1024.

[16] Komasawa N, Atagi K, Ueki R, Nishi S, Kaminoh Y, Tashiro C. Comparison of optic laryngoscope Airtraq® and Miller laryngoscope for tracheal intubation during infant cardiopulmonary resuscitation. Resuscitation. 2011; 82: 736–739.

[17] Komasawa N, Ueki R, Kaminoh Y, Nishi S. Comparison of the Miller laryngoscope and videolaryngoscope for tracheal intubation by novice doctors during neonatal cardiopulmonary resuscitation: a randomized crossover simulation trial. American Journal of Perinatology. 2015; 32: 809–814.

[18] Komasawa N, Ueki R, Yamamoto N, Nishi S, Kaminoh Y, Tashiro C. Comparison of pentax-AWS airwayscope, Airtraq and Miller laryngoscope for tracheal intubation by novice doctors during infant cardiopulmonary resuscitation simulation: a randomized crossover trial. Journal of Anesthesia. 2013; 27: 778–780.

[19] Rodríguez-Núñez A, Moure-González J, Rodríguez-Blanco S, Oulego-Erroz I, Rodríguez-Rivas P, Cortiñas-Díaz J. Tracheal intubation of pediatric manikins during ongoing chest compressions. does Glidescope® videolaryngoscope improve pediatric residents’ performance? European Journal of Pediatrics. 2014; 173: 1387–1390.

[20] Smereka J, Madziala M, Dunder D, Makomaska-Szaroszyk E, Szarpak L. Comparison of Miller laryngoscope and UEScope videolaryngoscope for endotracheal intubation in four pediatric airway scenarios: a randomized, crossover simulation trial. European Journal of Pediatrics. 2019; 178: 937–945.

[21] Szarpak L, Truszewski Z, Czyzewski L, Gaszynski T, Rodríguez-Núñez A. A comparison of the McGrath-MAC and Macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. a randomized, crossover, manikin study. The American Journal of Emergency Medicine. 2016; 34: 1338–1341.

[22] Szarpak Ł, Karczewska K, Czyżewski Ł, Truszewski Z, Kurowski A. Airtraq Laryngoscope versus the conventional macintosh laryngoscope during pediatric intubation performed by nurses: a randomized crossover manikin study with three airway scenarios. Pediatric Emergency Care. 2017; 33: 735–739.

[23] Szarpak Ł, Czyżewski Ł, Kurowski A, Truszewski Z. Comparison of the TruView PCD video laryngoscope and macintosh laryngoscope for pediatric tracheal intubation by novice paramedics: a randomized crossover simulation trial. European Journal of Pediatrics. 2015; 174: 1325–1332.

[24] Szarpak Ł, Czyżewski Ł, Truszewski Z, Kurowski A, Gaszyński T. Comparison of Coopdech®, CoPilot®, Intubrite®, and Macintosh laryngoscopes for tracheal intubation during pediatric cardiopulmonary resuscitation: a randomized, controlled crossover simulation trial. European Journal of Pediatrics. 2015; 174: 1517–1523.

[25] Szarpak Ł, Czyżewski Ł, Kurowski A. Comparison of the Pentax, Truview, GlideScope, and the Miller laryngoscope for child intubation during resuscitation. The American Journal of Emergency Medicine. 2015; 33: 391–395.

[26] Szarpak L, Karczewska K, Evrin T, Kurowski A, Czyzewski L. Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child CPR: a randomized crossover manikin trial. The American Journal of Emergency Medicine. 2015; 33: 946–950.

[27] Szarpak Ł, Kurowski A, Czyżewski Ł, Madziała M, Truszewski Z. Comparison of infant intubation through the TruView EVO2, TruView PCD, and Miller laryngoscope by paramedics during simulated infant cardiopulmonary resuscitation: a randomized crossover manikin study. The American Journal of Emergency Medicine. 2015; 33: 872–875.

[28] Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database of Systematic Reviews. 2017; 5: Cd011413.

[29] Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Pediatric Anesthesia. 2014; 24: 1056–1065.

[30] Gupta A, Kamal G, Gupta A, Sehgal N, Bhatla S, Kumar R. Comparative evaluation of CMAC and Truview picture capture device for endotracheal intubation in neonates and infants undergoing elective surgeries: a prospective randomized control trial. Pediatric Anesthesia. 2018; 28: 1148–1153.

[31] Kaji AH, Shover C, Lee J, Yee L, Pallin DJ, April MD, et al. Video versus direct and augmented direct laryngoscopy in pediatric tracheal intubations. Academic Emergency Medicine. 2020; 27: 394–402.

[32] Park R, Peyton JM, Fiadjoe JE, Hunyady AI, Kimball T, Zurakowski D, et al. The efficacy of GlideScope® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry. British Journal of Anaesthesia. 2017; 119: 984–992.

[33] Sola C, Saour A, Macq C, Bringuier S, Raux O, Dadure C. Children with challenging airways: what about GlideScope® video-laryngoscopy?Anaesthesia Critical Care & Pain Medicine. 2017; 36: 267–271.

[34] Sharma A, Sinha R, Ray B, Pandey R, Punj J, Darlong V, et al. Com-parison of the C-MAC video laryngoscope size 2 Macintosh blade with size 2 C-MAC D-Blade for laryngoscopy and endotracheal intubation in children with simulated cervical spine injury: a prospective randomized crossover study. Journal of Anaesthesiology Clinical Pharmacology. 2019; 35: 509.

[35] Kennedy CC, Cannon EK, Warner DO, Cook DA. Advanced airway management simulation training in medical education. Critical Care Medicine. 2014; 42: 169–178.

[36] Komasawa N, Ueki R, Kaminoh Y, Nishi S. Comparison of the Miller laryngoscope and videolaryngoscope for tracheal intubation by novice doctors during neonatal cardiopulmonary resuscitation: a randomized crossover simulation trial. American Journal of Perinatology. 2015; 32: 809–814.

[37] Kriege M, Piepho T, Buggenhagen H, Noppens RR. Comparison of GlideScope® Cobalt and McGrath® Series 5 video laryngoscopes with direct laryngoscopy in a simulated regurgitation/aspiration scenario. Medical Clinic-Intensive Care and Emergency Medicine. 2015; 110: 218–224. (In German)

[38] Van Zundert AA, Pieters BM. Videolaryngoscopy offers us more than classic direct laryngoscopy. Minerva Anestesiologica. 2015; 81: 933–934.

[39] Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, et al. Effect of a Strategy of a supraglottic airway device vs. tracheal intubation during out-of-hospital cardiac arrest on functional outcome. JAMA. 2018; 320: 779.

[40] Gausche M, Lewis RJ, Stratton SJ, Haynes BE, Gunter CS, Goodrich SM, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA. 2000; 283: 783.

[41] Hansen ML, Lin A, Eriksson C, Daya M, McNally B, Fu R, et al. A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database. Resuscitation. 2017; 120: 51–56.

[42] Ohashi-Fukuda N, Fukuda T, Doi K, Morimura N. Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest. Resuscitation. 2017; 114: 66–72.

[43] Blackburn MB, Wang SC, Ross BE, Holcombe SA, Kempski KM, Blackburn AN, et al. Anatomic accuracy of airway training manikins compared with humans. Anaesthesia. 2021; 76: 366–372.

[44] Schebesta K, Hüpfl M, Ringl H, Machata A, Chiari A, Kimberger O. A comparison of paediatric airway anatomy with the SimBaby high-fidelity patient simulator. Resuscitation. 2011; 82: 468–472.

[45] Schebesta K, Hüpfl M, Rössler B, Ringl H, Müller M, Kimberger O. Degrees of reality. Anesthesiology. 2012; 116: 1204–1209.

[46] Dieckmann P, Lippert A, Glavin R, Rall M. When things do not go as expected: scenario life savers. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2010; 5: 219–225.

[47] Sanfilippo F, Sgalambro F, Chiaramonte G, Santonocito C, Burgio G, Arcadipane A. Use of a Combined laryngo-bronchoscopy approach in difficult airways management: a pilot simulation study. Turkish Journal of Anaesthesiology and Reanimation. 2019; 47: 464–470.

[48] Sanfilippo F, La Via L, Tigano S, Morgana A, La Rosa V, Astuto M. Trial sequential analysis: the evaluation of the robustness of meta-analyses findings and the need for further research. Euromediterranean Biomedical Journal. 2021; 16: 104–107.



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