a Department of Emergency Medicine, Mayo Clinic, Rochester, MNb Knowledge Synthesis and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNc Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MNd Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, MNe Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MNf Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazilg Mayo Clinic Libraries, Rochester, MN
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Study objective:We conduct a systematic review and meta-analysis to evaluate the effectiveness of apneic oxygenation during emergency intubation.Methods:We searched Ovid MEDLINE, Ovid EMBASE, Ovid CENTRAL, and Scopus databases for randomized controlled trials and observational studies from 2006 until July 2016, without language restrictions. Gray literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate first-pass success rates, incidence of hypoxemia, and lowest peri-intubation SpO2 between apneic oxygenation and standard oxygenation cases.Results:A total of 1,386 studies were screened and 77 selected for full-text review. A total of 14 studies were included for qualitative analysis, and 8 studies (1,837 patients) underwent quantitative analysis. In the meta-analysis of 8 studies (1,837 patients), apneic oxygenation was associated with decreased hypoxemia (odds ratio [OR] 0.66; 95% confidence interval [CI] 0.52 to 0.84), but was not associated with decreased severe hypoxemia (6 studies; 1,043 patients; OR 0.86; 95% CI 0.47 to 1.57) or life-threatening hypoxemia (5 studies; 1,003 patients; OR 0.90; 95% CI 0.52 to 1.55). Apneic oxygenation was associated with increased first-pass success rate (6 studies; 1,658 patients; OR 1.59; 95% CI 1.04 to 2.44) and increased lowest peri-intubation SpO2 (6 studies; 1,043 patients; weighted mean difference 2.2%; 95% CI 0.8% to 3.6%).Conclusion:In this meta-analysis, apneic oxygenation was associated with increased peri-intubation oxygen saturation, decreased rates of hypoxemia, and increased first-pass intubation success.