The Impact of the COVID-19 Pandemic on Airway Management with Supraglottic Airway Devices among Out-of-hospital Cardiac Arrests: a Systematic Review and Meta-Analysis

Introduction: The COVID-19 pandemic has led to increased cases of out-of-hospital cardiac arrest (OHCA), impacting emergency medical services and necessitating changes in resuscitation protocols to protect healthcare workers from virus transmission. Amidst these challenges, there's a shift in prehospital airway management techniques, with a renewed focus on endotracheal intubation over supraglottic airway devices for better protection against aerosol spread during cardiopulmonary resuscitation. This systematic review and meta-analysis aimed to examine the influence of the COVID-19 pandemic on the use of SGA as a method of securing the airway during out-of-hospital cardiac arrest. Material and methods: PubMed Central, Scopus, EMBASE, and the Cochrane Library databases were systematically searched. English-language literature was searched up to December 5th, 2023. This search was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Fixed and random effects models were used to undertake the meta-analysis when appropriate. The risk of bias was assessed through the Newcastle-Ottawa Scale. Results: Fifteen studies met the inclusion criteria for the meta-analysis. Pooled analysis showed that SGAs were chosen as the method of airway protection in 46.3% and 49.8% of cases, pre- vs. during the COVID-19 pandemic (OR = 0.76; 95%CI: 0.65 to 0.90; p = 0.001). In the case of endotracheal intubation, statistically significant differences were also observed in the frequency of use during OHCA in the pre-pandemic period vs. during the COVID-19 pandemic period (19.0% vs. 14.2%, respectively; OR = 1.66; 95%CI: 1.20 to 2.28; p = 0.002). Conclusions: The study's conclusions indicate a significant increase in the use of supraglottic airway devices during the COVID-19 pandemic for out-of-hospital cardiac arrests. Additionally, a decrease in the use of endotracheal intubation was observed. Effective airway management correlates with better outcomes after cardiac arrests, although the specific impact of these techniques during the pandemic remains unclear.