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

Am J Emerg Med. 2017 Aug;35(8):1184-1189. doi: 10.1016/j.ajem.2017.06.029. Epub 2017 Jun 15.

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.

Keywords: Airway management; Apneic oxygenation; Crash intubation; Oxygenation; Rapid sequence intubation.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Canada
  • Critical Illness / therapy*
  • Humans
  • Hypoxia / physiopathology
  • Hypoxia / prevention & control
  • Hypoxia / therapy*
  • Incidence
  • Intubation, Intratracheal / methods*
  • Oxygen Inhalation Therapy / methods*
  • Respiration, Artificial