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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

secretions

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