Difficult airway management: An analysis of systematic review evidence underpinning clinical practice guidelines

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.

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.

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.

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.