Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, China.
BMC Anesthesiol. 2023 Jul 7;23(1):232. doi: 10.1186/s12871-023-02191-0.
Cook Stage extubation is a tool developed by Cook Medical for patients with difficult airways. Multiple clinical studies demonstrated the effectiveness and safety of Cook Stage extubation Set (CSES). Currently, no systematic review evidence has been published in this field. Therefore, this study aimed to review the clinical success rate, safety, and tolerability of CSES in patients with difficult airways.
The inclusion criteria were based on the population, intervention, comparator, outcomes, and study designs. An electronic search was conducted, and the following databases were used: PubMed, EMBASE, Cochrane Library, and Web of Science. Search keywords included difficult airway and CSES. The primary outcome was the CSES clinical success rate.The Joanna Briggs Institute Critical Appraisal tools for Case Series were used to assess the risk of bias in the included studies. R studio, version 4.2.2. was used to perform the statistical analysis. The Cochrane Q and I statistics were used to test the heterogeneity among all studies. Details of the included case reports were summarized in the systematic review part.
Five studies were eligible for meta-analysis, and 7 case reports were included for systematic review. The pooled overall CSES clinical success rate was 93% (95% CI: 85%, 97%). The CSES intolerable and complication incidence rates were 9% (95% CI: 5%, 18%) and 5% (95% CI: 2%, 12%), respectively. CSES clinical success rate was influenced by the study center and study design. The success rate of CSES was higher in multicenter and prospective design studies. Seven case reports have documented the successful operation of CSES intubation in obese, tall, oncologist, and pediatric patients.
This meta-analysis suggested that CSES have achieved a high clinical success rate in adult and pediatric patients with different physical conditions and types of surgery. The results of all original studies and meta-analysis confirmed a remarkably high tolerance rate and low overall complication rate. However, regardless of the tools chosen, a personalized, safe intubation strategy and a highly qualified anesthesiologist should be considered as the fundamental guarantee of a high clinical success rate. Future studies should also focus on the success rate of reintubation using CSES in patients with airway difficulties.
Cook 阶段拔管是 Cook 医疗公司为气道困难患者开发的一种工具。多项临床研究证明了 Cook 阶段拔管套件（CSES）的有效性和安全性。目前，该领域尚未发表系统评价证据。因此，本研究旨在回顾 CSES 在气道困难患者中的临床成功率、安全性和耐受性。
纳入标准基于人群、干预、对照、结局和研究设计。进行了电子检索，并使用了以下数据库：PubMed、EMBASE、Cochrane 图书馆和 Web of Science。检索关键词包括困难气道和 CSES。主要结局是 CSES 的临床成功率。使用 Joanna Briggs 研究所病例系列的批判性评价工具评估纳入研究的偏倚风险。使用 R 工作室，版本 4.2.2 进行统计分析。使用 Cochrane Q 和 I 统计量检验所有研究之间的异质性。纳入病例报告的详细信息在系统评价部分进行了总结。
五项研究符合荟萃分析条件，七项病例报告纳入系统评价。总体 CSES 临床成功率为 93%（95%CI：85%，97%）。CSES 不耐受和并发症发生率分别为 9%（95%CI：5%，18%）和 5%（95%CI：2%，12%）。CSES 临床成功率受研究中心和研究设计的影响。多中心和前瞻性设计研究中 CSES 的成功率更高。七份病例报告记录了 CSES 成功用于肥胖、高大、肿瘤学家和儿科患者的插管操作。
荟萃分析表明，CSES 在不同身体状况和手术类型的成年和儿科患者中均取得了较高的临床成功率。所有原始研究和荟萃分析的结果均证实了极高的耐受性和较低的总体并发症发生率。然而，无论选择何种工具，个性化、安全的插管策略和高素质的麻醉师都应被视为高临床成功率的基本保障。未来的研究还应关注 CSES 在气道困难患者中再次插管的成功率。
