# Exploring the role of trained surgical care nurses in cricothyrotomy and other emergency procedures: a systematic review and meta-analysis

## TL;DR

This study finds that trained nurses can safely perform emergency surgeries like cricothyrotomy when healthcare professionals are scarce, such as during the COVID-19 pandemic.

## Contribution

The study provides the first meta-analysis on the efficacy of nurse-performed emergency surgeries, offering evidence for their safe use in critical situations.

## Key findings

- Trained nurses performing emergency surgeries had a pooled relative risk of 0.88 and odds ratio of 0.80, indicating effectiveness.
- Minimal complications were observed in nurse-conducted emergency procedures.
- The studies showed low heterogeneity, suggesting consistent outcomes across the analyzed data.

## Abstract

There is a severe shortage of healthcare professionals, emphasized in a stark manner by the recent COVID-19 pandemic, where the mortality rate was primarily a consequence of medical professionals lacking the technical know-how for conducting specialized procedures. Therefore, this systematic review and meta-analysis aimed to evaluate the success rates of nurse-performed emergency surgeries, focusing on trauma care (e.g., cricothyrotomy), rural obstetric emergencies (e.g., caesarean section, hysterectomy), and general procedures (e.g., laparotomy, appendectomy).

A systematic search was conducted across eight major databases (PubMed, Embase, CINAHL, Scopus, Web of Science, PsycINFO, Cochrane Library, ProQuest) following PRISMA guidelines. Four eligible studies were identified, and data were pooled using a fixed-effects model.

The synthesis of data across the four selected studies revealed a pooled relative risk (RR) of 0.88 (95% CI: 0.78, 1.00) and odds ratio (OR) of 0.80 (95% CI: 0.65, 0.99) about the efficacy in emergency surgeries conducted by nurses. These four studies were the only ones meeting our strict inclusion criteria of reporting outcome data on nurse-performed emergency procedures. An analysis of heterogeneity demonstrated minimal variability among the studies, with a Chi2 value of 1.54, df = 3, P = 0.67, and I2 = 0%. The test for overall effect yielded a statistically significant Z statistic of 2.03 (P = 0.04), indicating a meaningful finding. The observed inferences also showed that the surgical procedures exhibited minimal complications.

This study suggests that trained nurses can safely and effectively perform selected emergency surgical procedures. While encouraging, the limited number of studies highlights the need for further research to confirm these findings and guide clinical practice.

Flowchart illustrating the process of emergency surgeries during COVID-19. It begins with \"Healthcare shortage\" leading to \"Emergency surgeries performed by nurses\". Data is collected from different databases for \"Identification,\" \"Screening,\" and \"Eligibility\". This progresses to a \"Meta-Analysis,\" concluding with \"Successful/safe emergency surgeries performed by nurses\". Arrows indicate the sequence.