Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis

• Published in: The American journal of emergency medicine 2017-08, Vol.35 (8), p.1184-1189
• Main Authors: Pavlov, Ivan, MD, Medrano, Sofia, MD, Weingart, Scott, MD
• Format: Article
• Language: English
• Subjects: Airway management; Apneic oxygenation; Bias; Canada; Clinical trials; Collaboration; Crash intubation; Critical care; Critical Illness - therapy; Emergency; Emergency medical care; Evidence-based medicine; Heterogeneity; Humans; Hypoxemia; Hypoxia - physiopathology; Hypoxia - prevention & control; Hypoxia - therapy; Incidence; Intensive care; Intubation; Intubation, Intratracheal - methods; Meta-analysis; Mortality; Motivation; Oxygen Inhalation Therapy - methods; Oxygenation; Rapid sequence intubation; Respiration, Artificial; Respiratory therapy; Systematic review
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.06.029

Abstract Study objective Apneic oxygenation has been advocated for the prevention of hypoxemia during emergency endotracheal intubation. Because of conflicting results from recent trials, the efficacy of apneic oxygenation remains unclear. We performed a systematic review and meta-analysis to investigate the effect of apneic oxygenation on the incidence of clinically significant hypoxemia during emergency endotracheal intubation. Methods MEDLINE, EMBASE, and PubMed databases were searched without language and time restrictions for studies of apneic oxygenation performed in a critical care setting. Meta-analysis was conducted with a random-effect model, and according to intention-to-treat allocation wherever applicable. Subgroup analyses were performed to ensure the robustness of findings across various clinical outcomes. Results Eight studies ( n = 1953) were included in the meta-analysis. The pooled absolute risk of clinically significant hypoxemia was 27.6% in the usual care group and 19.1% in the apneic oxygenation group, without any heterogeneity across studies (I2 = 0%; p = 0.42). Apneic oxygenation reduced the relative risk of hypoxemia by 30% (95% confidence interval 0.59 to 0.82). There was a trend toward lower mortality in the apneic oxygenation group (relative risk of death 0.77; 95% confidence interval 0.59 to 1.02). Conclusion Apneic oxygenation significantly reduces the incidence of hypoxemia during emergency endotracheal intubation. These findings support the inclusion of apneic oxygenation in everyday clinical practice.