Patient Ability to Use Old versus New/Modified Model Adrenaline Autoinjection Emergency Medical Devices for Anaphylaxis in Prehospital Setting: A Systematic Review and Meta-Analysis.

Leong Chow Wei,Mohd Noor Norhayati,Abu Yazid Md Noh,Andey Rahman,Mohd Boniami Yazid

doi:10.3390/healthcare10020183

Leong Chow Wei, Mohd Noor Norhayati + Show 3 more

Open Access

https://doi.org/10.3390/healthcare10020183

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Abstract

Background: The goal of this study was to determine the individual’s ability to use new/modified model AAI compared to old model AAIs devices for anaphylaxis. Methods: The protocol was established a priori and published on PROSPERO (CRD42021229691) and was conducted based on PRISMA guidelines. MEDLINE and CENTRAL were searched until 31 January 2021. Only RCTs were included in this review. Primary studies comparing old model AAI to new/modified model AAI emergency medical devices were included. Primary outcomes included number of successful administrations, and number of individuals to complete all steps. Secondary outcomes included successful removal of device safety guards, placement of correct end of the device against the thigh and holding of the device in place for adequate time after administration; the frequency of an adverse event (digital injection); individual preferences in terms of size, individual preference in terms of ease for carrying, overall patient preference; and the mean time of delivery. Results: Overall, seven trials consisting of 1359 patients were analyzed. Reporting of adverse events was limited to digital injection, which was significantly higher in the old model AAI (RR 6.90, 95% CI 3.27 to 14.57; I2 statistic = 0%; p < 0.001; four trials, 610 participants; high quality evidence). No significant difference was found regarding successful administration between the old model AAI and new/modified model AAI (RR 0.76, 95% CI 0.52 to 1.11; I2 statistic = 96%; p = 0.16; seven trials, 2196 participants; low quality evidence). Conclusions: We cannot make any new recommendations on the effectiveness of different models of AAIs regarding successful administration. However, considering the aspect of safety, we think that mew/modified model AAI can be chosen as the old model AAI was associated with a higher frequency of the adverse event (digital injection).

Highlights

We excluded a total of 72 records, the main reason being analyses of those trials were irrelevant within our objective, such as the measurement of the bioavailability, pharmacokinetics and pharmacodynamics of adrenaline in anaphylaxis, evaluation of how communities manage patients with anaphylaxis, assessment of effective training and skill retention for the public use of AAIs, and assessment of the impact of anaphylaxis on health-related quality of life (HRQL)
When we screened through the randomized control trials (RCTs), we unable to find out which critical step most often led to successful administration
Reporting of adverse events was limited to digital injection, which significantly increased with use of the old model AAI, but we unable to proceed with subgroup analysis due to limited data in each RCT

Summary

Introduction

Adrenaline (epinephrine) is the first and most important treatment for anaphylaxis, and it should be administered as soon as anaphylaxis is recognized to prevent the progression to life-threatening symptoms [3]. The adrenaline delivered by the device is an emergency treatment for anaphylactic reaction [4]. Several types of adrenaline autoinjectors are available. These include the EpiPen (most used worldwide), the Anapen, the Adrenaclick, the Jext, and the Twinject. Many years have passed, there is still a limited number of AAI currently available. As of 2018, three types of AAI were available in the US: Adrenaclick, Auvi-Q, and EpiPen. As of 2018, EpiPen is the only epinephrine autoinjector available for sale in Canada [5]. Each has limitations concerning dose, needle length, shelf life, and a lack of user-friendly design [6,7]

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