Efficacy of simulation-based training of airway management in preparing hospitals for the COVID-19 pandemic: A systematic review

Myrtha Magdalena Kohler¹Michaela Kolbe^2,3Benedict Körtgen¹Stephanie Angst⁴Anna Maria Barbul⁵Lisa Seufert⁶Radek Hasal⁴Lea Buehrer⁷Ulrike Held⁷Bastian Grande^3,8*

• ¹University Hospital Zürich, Zurich, Switzerland
• ²UniversitatsSpital Zurich Simulationszentrum, Zürich, Switzerland
• ³Eidgenossische Technische Hochschule Zurich, Zürich, Switzerland
• ⁴Stadtspital Zurich Triemli, Zürich, Switzerland
• ⁵Kantonsspital Winterthur, Winterthur, Switzerland
• ⁶Sir Charles Gairdner Hospital, Nedlands, Australia
• ⁷Epidemiology, Biostatistics and Prevention Institute, Universitat Zurich, Zürich, Switzerland
• ⁸UniversitatsSpital Zurich, Zürich, Switzerland

Background: In response to the coronavirus pandemic, hospitals worldwide implemented simulation-based training to prepare healthcare providers for the revised protocols regarding airway management in infectious COVID-19 patients. We conducted a systematic review of simulation studies regarding airway management of COVID-19 patients with the aim of analyzing the findings of these studies and consolidating evidence-based recommendations in order to optimize the response to possible future pandemics. Methods: We performed a systematic literature search of PubMed, Embase, MedLine and Cochrane Library on August 25th 2022. As the different studies measured different outcomes (e.g. only confidence, only knowledge or both) in different ways, a random effects model was used for meta-analysis and change scores were calculated. Results: The systematic review included 20 studies after screening 141 articles. Meta-analyses revealed significant improvements in confidence and knowledge of the participants after the simulation training, supported by negative standardized mean differences (Cohen's d). Sensitivity analysis confirmed robust results across correlation estimates. However, there was a high risk of publication bias, as funnel plots showed asymmetry and studies the 95% confidence interval. Conclusions: This systematic review highlights the effectiveness of simulation training in improving healthcare providers' confidence and knowledge during pandemic-related airway management. The findings underscore the positive impact of simulation-based education, as demonstrated by significant pre-to post-training improvements. However, the observed publication bias suggests that further high-quality, unbiased studies are necessary to strengthen the evidence base and inform future training programs for pandemic preparedness.