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

Leal, Jenine; Farkas, Brenlea; Mastikhina, Liza; Flanagan, Jordyn; Skidmore, Becky; Salmon, Charleen; Dixit, Devika; Smith, Stephanie; Tsekrekos, Stephen; Lee, Bonita; Vayalumkal, Joseph; Dunn, Jessica; Harrison, Robyn; Cordoviz, Melody; Dubois, Roberta; Chandran, Uma; Clement, Fiona; Bush, Kathryn; Conly, John; Larios, Oscar

doi:10.1186/s13756-022-01133-8

Antimicrobial Resistance & Infection Control

Table 5 Summary of findings from studies that included statistical comparisons with respect to transmission of SARS for Specific AGMPs*

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

AGMP	AGMP activity	Author	Study design	Sample size	Odds ratio^a (95%CI)
Airway Suctioning	After intubation	Loeb [63]	Retrospective cohort	AGMP: n = 19 Control: n = 13	0.68 (0.21 to 2.26)
	Before intubation	Loeb [63]	Retrospective cohort	AGMP: n = 4 Control: n = 28	4.2 (1.58 to 11.14)
	Endotracheal aspirate	Loeb [63]	Retrospective cohort	AGMP: n = 12 Control: n = 20	1.0 (0.29 to 3.45)
	Present in room after intubation	Raboud [55]	Retrospective cohort	AGMP: n = 165 Control: n = 459	1.63 (0.97 to 2.73)
	Present in room before intubation	Raboud [55]	Retrospective cohort	AGMP: n = 113 Control: n = 511	1.78 (0.97 to 3.29)
Bronchoscopy	Performed	Loeb [63]	Retrospective cohort	AGMP: n = 2 Control: n = 30	2.14 (0.46 to 9.9)
CPR	Performed	Loeb [63]	Retrospective cohort	AGMP: n = 3 Control: n = 29	AGMP cases: 0 Control cases: 8 p = 0.55
	Present in room during compressions	Raboud [55]	Retrospective cohort	AGMP: n = 9 Control: n = 615	6.39 (3.27 to 12.5)
	Present in room during defibrillation	Raboud [55]	Retrospective cohort	AGMP: n = 4 Control: n = 620	15.73 (5.27 to 46.9)
	Close proximity (< 1 m)	Liu [62]	Case–control	AGMP: n = 15 Control: n = 462	AGMP cases: 5 Control cases: 51 p = 0.02
Intubation	Performed	Chen [65]	Retrospective cohort	AGMP: n = 33 Control: n = 715	8.03 (3.9 to 16.56)
	Performed or assisted	Fowler [64]	Retrospective cohort	AGMP: n = 14 Control: n = 62	RR: 13.29 (2.99 to 59.04)
	Performed	Loeb [63]	Retrospective cohort	AGMP: n = 4 Control: n = 28	4.2 (1.58 to 11.14)
	Present in room	Raboud [55]	Retrospective cohort	AGMP: n = 144 Control: n = 480	2.92 (1.7 to 5.03)
	Close proximity (< 1 m)	Liu [62]	Case–control	AGMP: n = 12 Control: n = 465	AGMP cases: 6 Control cases: 45 p = < 0.001
	Performed/Assisted	Teleman [58]	Case–control	AGMP: n = 6 Control: n = 80	1.5 (0.4 to 5.4)
	Performed	Pei [60]	Case–control	AGMP: n = 37 Control: n = 406	30.79 (7.91 to 119.84)^b
Manual Ventilation	Performed	Loeb [63]	Retrospective cohort	AGMP: n = 7 Control: n = 25	1.19 (0.3 to 4.65)
	Present in room during on-invasive ventilation	Raboud [55]	Retrospective cohort	AGMP: n = 109 Control: n = 515	1.37 (0.14 to 13.1)
	Present in room during manual ventilation after intubation	Raboud [55]	Retrospective cohort	AGMP: n = 120 Control: n = 504	1.83 (1.09 to 3.07)
	Present in room during manual ventilation before intubation	Raboud [55]	Retrospective cohort	AGMP: n = 118 Control: n = 506	2.68 (1.34 to 5.35)
	Present > 30 min during use of NPPV	Scales [59]	Retrospective cohort	AGMP: n = 22 Control: n = 9	105 (3 to 3035)
Mechanical Ventilation	Present in room	Raboud [55]	Retrospective cohort	AGMP: n = 236 Control: n = 388	1.06 (0.49 to 2.3)
Nebulizer	Performed	Loeb [63]	Retrospective cohort	AGMP: n = 5 Control: n = 27	3.24 (1.11 to 9.42)
Oxygen administration	Manipulated BiPAP mask	Loeb [63]	Retrospective cohort	AGMP: n = 6 Control: n = 26	2.6 (0.8 to 7.99)
	Manipulated oxygen mask	Loeb [63]	Retrospective cohort	AGMP: n = 14 Control: n = 18	9 (1.25 to 64.89)
	Present in room during procedure	Raboud [55]	Retrospective cohort	AGMP: n = 108 Control: n = 516	0.67(0.43 to 1.04)
	Performed	Teleman [58]	Case–control	AGMP: n = 17 Control: n = 69	1.0 (0.3 to 2.8)
Tracheostomy	Performed	Chen [65]	Retrospective cohort	AGMP: n = 17 Control: n = 731	4.15 (1.5 to 11.5)

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
AGMP aerosol-generating medical procedure; CI confidence interval; RR risk ratio
^aOdds Ratio unless otherwise specified
^bAdjusted odds ratio reported because unadjusted odds ratios could not be found

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ISSN: 2047-2994

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