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

Abstract

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 “2nd generation 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).