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Table 3 Summary of findings from the studies that included statistical comparisons with respect to transmission of COVID-19 during AGMPs and where the AGMPs were not specified or were combined *

From: Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review

Author Study design Aerosol-generating medical procedures
(as described in the studies)
Sample size Odds ratioa (95%CI)
Haller [49] Prospective cohort AGMPs Combined: Bronchoscopies, intubation/extubation, gastroscopy, transesophageal echocardiography, reanimation, non-invasive ventilation, and suction of tracheal
AGMP: n = NR
Control: n = NR
aOR: 0.96 (0.75 to 1.24)b
aHR: 1.18 (0.96 to 1.45)c
Nakagama [45] Prospective cohort AGMPs Combined: Airway suctioning, bronchoscopy, CPR, endotracheal intubation/extubation, bag mask ventilation, non-invasive ventilation, nebulizer administration, sputum induction, oxygen supplementation via tracheostomy, tracheotomy AGMP: n = 212
Control: n = 202
RR: 1.59 (NR); p = 0.057
Brown [43] Retrospective cohort AGMPs Combined: Endotracheal intubation, supraglottic airway insertion, bag-valve-mask (BVM) ventilation (with or without chest compressions for CPR), continuous positive airway pressure nonrebreather mask oxygen (high-flow oxygen 15L/min), nebulizer medication therapy, CPR AGMP: n = 705
Control: n = 1389
IRRd: 1.64 (0.22 to 12.26)
Ran [42] Retrospective cohort Specific AGMPs and AGMPs Combined: High exposure operation (medical or surgical procedures that generate respiratory aerosols including tracheal intubation, tracheotomy, tracheal tube removal, CPR, sputum suction, fiber bronchoscopy, laryngoscope) AGMP: n = 13
Control: n = 59
0.54 (0.19 to 1.53)
Shah [40] Retrospective cohort AGMPs Combined: Tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy AGMP: n = 225
Control: n = 120
AGMP cases: 3
Control cases: 5
p = 0.13
Heinzerling [48] Cohort Specific AGMPs and AGMPs Combined: Airway suctioning, noninvasive positive pressure ventilation including BiPAP, manual ventilation, nebulizer treatments, breaking the ventilator circuit, sputum induction, intubation, bronchoscopy AGMP: n = 17
Control: n = 20
AGMP cases: 2
Control cases: NR
p = 0.58
Lormans [36] Cohort Specific AGMPs and AGMPs Combined: Broncho-alveolar lavage (more than 5 times),any assistance with either intubation or broncho-alveolar lavage, Intubation (more than once) AGMP: n = NR
Control: n = NR
0.36 (0.1 to 1.26)
Lentz [32] Case–control Specific AGMPs and AGMPs Combined: Intubation, extubation, open respiratory suctioning, bronchoscopy, nebulizer use, non-invasive positive pressure ventilation (NIPPV), tracheotomy, cardiopulmonary resuscitation AGMP: n = 321
Control: n = 634
0.90 (0.60 to 1.2)
Chano [46] Cross-sectional Not specifically identified in the paper but list of AGMPs combined received from personal communication with the author: Tracheal suction, tracheal intubation, extubation, bronchoscopy, nebulizer therapy AGMP: n = 893
Control: n = 333
AGMP cases: 20
Control cases: 1
p < 0.001
Dimcheff [30] Cross-sectional Not specifically identified AGMP: n = 155
Control: n = 1291
0.62 (0.25 to 1.56)
Firew [31] Cross-sectional survey AGMPs Combined: Respiratory/airway suctioning, intubation, nasopharyngeal aspiration, nebulizer treatment- AGMP: n = 1080
Control: n = 774
PR: 1.09 (0.95 to 1.26)
Lai [50] Cross-sectional survey Not specifically identified AGMP: n = 43
Control: n = 282
AGMP cases: 17
Control cases: 134
p = 0.328
Paris [44] Cross-sectional survey Specific AGMPs and AGMPs Combined: Nasopharyngeal sampling, ear, nose and throat examinations, upper respiratory tract, nasogastric tube insertion, aerosol generating procedures (not specified but referred to as actions on upper respiratory tract) AGMP: n = 999
Control: n = 2071
AGMP cases: 44
Control cases: 68
p = 0.12
Pérez-García [47] Cross-sectional Not specifically described AGMP: n = NR
Control: n = NR
2.54 (1.71 to 3.77)
Rzepliński [37] Cross-sectional Not specifically described AGMP: n = 332
Control: n = 1240
AGMP cases: 79
Control cases: 278
p = 0.6
Vitrat [39] Cross-sectional AGMPs Combined: Nasopharyngeal test, intubation, etc. (from survey), oral intubation, aerosolized therapy, high flow oxygen (in discussion) AGMP: n = 1033
Control: n = 2421
1.7 (1.15 to 2.49)e
2.03 (1.36 to 3.02)f
  1. *Bolded estimates represent statistically significant results (p < 0.05). Details pertaining to patients and settings and studies that only reported count data but no statistical comparisons can be found in Table 2
  2. AGMP aerosol-generating medical procedure; aOR adjusted Odds Ratio; aHR adjusted Hazard Ratios; NR not reported; CI confidence interval; RR risk ratio; IRR incidence rate ratio; PR prevalence ratio
  3. aUnadjusted Odds Ratio unless otherwise specified
  4. bAdjusted Odds Ratios of SARS-CoV-2 seroconversion reported because unadjusted odds ratios could not be found
  5. cAdjusted Hazard Ratios of SARS-CoV-2 PCR/rapid antigen tests reported because unadjusted odds ratios could not be found
  6. dAGMP status of comparator unclear
  7. eAGMP with systematic use of FFP2 compared to non-AGMP exposure
  8. fAGMP without systematic use of FFP2 compared to non-AGMP exposure