Difficult Airway Management: An Analysis of Systematic Review Evidence Underpinning Clinical Practice Guidelines

Anaesth Crit Care Pain Med. 2025 May 1:101534. doi: 10.1016/j.accpm.2025.101534. Online ahead of print.

ABSTRACT

BACKGROUND: Systematic reviews (SRs) underpin the recommendations in clinical practice guidelines (CPGs) for difficult airway management (DAM), yet their methodological and reporting quality varies, potentially impacting clinical decision-making and patient outcomes. Accurate evidence-based medicine is crucial for healthcare workers to make informed decisions in managing a difficult airway, ensuring safer practices and improved outcomes. This study evaluates these SRs using PRISMA and AMSTAR-2 tools to provide insights into their reliability and identify areas for improvement.

METHODS: A comprehensive PubMed search identified DAM CPGs published between 2015 and 2021. SRs cited within these CPGs were screened for eligibility and assessed using the PRISMA and AMSTAR-2 checklists to evaluate reporting clarity and methodological rigor. A secondary analysis compared quality scores between Cochrane and non-Cochrane SRs, emphasizing their relative contribution to guideline quality and applicability.

RESULTS: Fourteen CPGs yielded 63 SRs, 20 of which directly informed guideline recommendations. The mean PRISMA and AMSTAR-2 completion scores for these SRs were 73.4% and 49.3%, respectively, with most SRs rated as moderate or critically low in quality. Only three Cochrane SRs were included, scoring higher on AMSTAR-2 than non-Cochrane SRs.

CONCLUSION: SRs cited in DAM CPGs demonstrate inconsistent quality, reflecting a need for stricter adherence to reporting and methodological standards. Limited use of Cochrane SRs may reduce the robustness of recommendations. Incorporating higher-quality SRs, particularly from Cochrane, and ensuring rigorous evaluation during guideline development are critical for enhancing DAM CPGs’ reliability, applicability, and impact on clinical practice and patient care.

PMID:40318848 | DOI:10.1016/j.accpm.2025.101534