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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:

† These authors contributed equally.


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.


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

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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.


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