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

Israel Baptista De Souza Borges,Marcel De Souza Quintana,Magali Rezende De Carvalho,Alexandre Barbosa De Oliveira

doi:10.1590/1518-8345.4024.3347

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 “2ndgeneration 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).

Highlights

Several emergency situations are triggered by the malicious or accidental use of chemical, biological or radiological agents, which can result in respiratory failure for the victims
The evaluation of the level of evidence presented in the studies by the GRADE system, with regard to the “reduction of time for performing direct laryngoscopy compared to the insertion of a supraglottic device” outcome, found a moderate level of evidence
The systematic review points to supraglottic devices as being faster to the detriment of orotracheal intubation, under the “reduction in the time to perform ventilatory support techniques” outcome

Summary

Introduction

Several emergency situations are triggered by the malicious or accidental use of chemical, biological or radiological agents, which can result in respiratory failure for the victims. In 2015, in Brazil, the first suspected case of Ebola was reported, which mobilized the health sector and provided the opportunity for the preparation of health professionals in relation to the specific protective equipment they should wear, as well as transportation and adequate health care addressed to the person with the suspected condition. This initiative was justified by the pathophysiology of the disease itself, which stimulates an inflammatory response, followed by an immuno-suppressive phase, causing respiratory failure due to blood aspiration and septic shock[5,6]

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Conclusion