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Table 1 List of the studies included in the systematic review and their characteristics

From: Endotracheal intubation to reduce aspiration events in acutely comatose patients: a systematic review

Study Population Method Enrollment Sampling Setting Sample size Inclusion criteria Operators Outcome Results
Non-traumatic patients
Donald [16] 2009 Poisoned patients Observational Prospective Non consecutive ED 26 GCS ≤ 8 ED physicians - Aspiration
- Hospital LOS
- Mortality
- Aspiration: none
- Hospital LOS: non-intubated group vs. intubated group (26 h vs. 5.4 days)
- Mortality: non-intubated group vs. intubated group (0 vs 1)
Duncan [8] 2009 Poisoned patients Observational Prospective Consecutive ED 73 GCS ≤ 15 ED physicians - Aspiration
- Admission to ICU
- Aspiration: none
- ICU admission: 1 in GCS ≤ 8 group
- Hospital LOS: GCS ≤ 8 vs GCS > 8 (26 h vs 14 h)
Eizadi-Mood [17] 2009 Poisoned patients Observational Retrospective n.a. ED 155 GCS ≤ 12 ED physician - Aspiration pneumonitis - Aspiration pneumonitis: intubation (OR = 0.07; 95%CI = 0.01–0.49)
[GCS (OR = 0.43; 95%CI = 0.30–0.62)]
Montassier [18] 2012 Poisoned patients Observational Prospective Consecutive? PH and ED 72 GCS ≤ 8 PH and ED physicians - Aspiration pneumonia - Aspiration pneumonia: 9/13 (69.2%) in delayed ED intubation group vs. 6/34 (17.7%) ED intubation group (p = 0.002).
[GCS > 8 group vs GCS ≤ 8 group (6 [24%] vs 15 [31.9%]; p = 0.48)]
Nielsen [6] 2012 Non-traumatic unconscious patients Observational Retrospective n.a. PH 557 GCS < 9 PH physicians - Intubation during hospitalization - 64/557 (11%) patients remained unconscious to ED; 12 (2%) of these were intubated in the ED
Dietze [19] 2014 Gamma-hydroxybutyric acid overdose patients Observational Retrospective n.a. ED 335 GCS ≤ 8 ED physicians - ED LOS
- Admission status
- ED LOS: intubated vs. non-intubated group + 41% (Exp B = 1.41, 95%CI = 1.19 to 1.65)
- Probability of hospital admission: intubated vs. non-intubated group (OR = 0.10, 95%CI = 0.02 to 0.65)
van Helmond [20] 2019 Gamma-hydroxybutyric acid overdose patients Observational Retrospective n.a. ED 158 GCS < 9 PH and ED physicians? - Aspiration - Major aspiration events were reported in 5 patients (2.4%; 95%CI: 0.8–5.5)
[2 required intubation (16.7%; 95%CI: 2.1–48.4)]
Trauma patients
Davis [21] 2005 TBI Observational Prospective Consecutive? PH 412 GCS ≤ 8 EMS providers - Pre-RSI hypoxia
- Aspiration
- Mortality
- Hypoxia: before RSI vs. after RSI (23.9% vs. 5.9%, OR 4.97, 95%CI = 3.07–8.07, p = 0.001)
- Aspiration: GCS ≤8 (χ2 p = 0.14; AUC = 0.55)
- Mortality: GCS ≤8 (χ2 p < 0.001 AUC = 0.58)
Irvin11 2010 TBI Observational Retrospective n.a. PH 10,948 GCS = 3 EMS providers? - Mortality - Mortality rate: hospital intubated vs. prehospital intubated group (35% vs. 62%; p < 0.0001)
Evans [22] 2011 TBI Observational Retrospective n.a. PH 197 TBI needed intubation EMS providers? - Pneumonia - GCS score in pneumonia group vs. non-pneumonia group (7.9 ± 0.9 vs 9.9 ± 0.4 p = 0.04)
- Use of BVM in pneumonia group vs. non-pneumonia group (18 [56.3%] vs. 56 [34.0%]; p = 0.02)
Emami [23] 2019 TBI Observational Retrospective n.a. PH 21,242 GCS < 9 PH physicians - Mortality - Mortality: intubated vs. non-intubated group (42.2% vs. 30.0%, respectively). In patients < 15 years old (42.2% vs. 33.4%; p = 0.03)
Adult Mixed cases
Steuerwald [24]
2018
Mixed adult patients Observational Retrospective n.a. PH 161 Adults patients who required airways management EMS providers - Aspiration - Aspiration: 59 cases (8%) in supraglottic device group vs. 91 cases (12%) in endotracheal tube group (p value = .359; relative risk = .841; 95%CI .329–2.152)
Pediatric Mixed cases
Tweed [12] 2018 Pediatric unconsciuous patients Observational Retrospective n.a. PH 104 Unconscious pediatric patients EMS providers - Oxygenation
- Mortality
- Inadequate oxygenation: 4% in intubated group; 9% in BVM patients; 32% in only oxygen group.
- Mortality:
Trauma patients: intubated vs. non-intubated group (RR 0.61 [95% CI, 0.35–1.06]; P = .082).
Non-traumatic patients: intubated vs. non-intubated group (RR 2.98 [95% CI, 1.18–7.56]; P = .021)
  1. N.a. Not available, ED Emergency Department, n.s. Not specified, TBI Traumatic brain injury, PH Pre-hospital, RSI Rapid sequence intubation, ICU Intensive care unit, LOS Length of stay, EMS Emergency medical system, GCS Glasgow Coma Scale, χ2 Chi-square, p p-value, OR Odds ratio, CI Confidence interval, AUC Area under the curve, h Hours, BVM Bag valve mask, Exp B Coefficient for the linear regression