Hermant 1991

Methods	Double‐blind, parallel‐arm, single‐centre, placebo‐controlled RCT.
Participants	12 participants with cirrhosis and an acute episode of hepatic encephalopathy defined as Grade IIIa with severely abnormal electroencephalography changes, but a Glasgow Coma Score of < 12 (Table 4). Proportion of men: not reported. Mean age ± SD: whole group 58.2 ± 5.4 years. Aetiology of liver disease: not reported. Proportion testing positive for benzodiazepines at baseline (Table 7): 0%.
Interventions	Intervention comparison: intravenous infusion flumazenil 0.2 mg/kg over 10 minutes versus placebo (saline). Total dose of flumazenil: 0.2 mg/kg. Cointerventions: none described.
Outcomes	Outcomes included in meta‐analyses: mortality (Table 8) and serious adverse events (Table 8).
Neuropsychiatric assessment	Baseline and post infusion: Glasgow Coma Scale (Table 4); Electroencephalography (Table 5). The timing of assessments post infusion was not described.
Inclusion period (date)	Not described.
Country	France.
Notes	Included data: the trial report did not specifically state the number of participants with (or without) improvement in hepatic encephalopathy separately for the allocation groups. Therefore, we were unable to include the trial in the analysis of this outcome measure. Article published in French (full translation available).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not reported.
Allocation concealment (selection bias)	Low risk	Concealed drug containers.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Blinding of participants and personnel.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Blinding of outcome assessment.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Trial report gave the impression that there were no missing outcome data although this was not specifically stated.
Selective reporting (reporting bias)	Low risk	Trial described clinically relevant outcomes. We had no access to information about outcomes described in the original protocol or information in trial registries.
For‐profit funding	Unclear risk	No information provided.
Other bias	Low risk	No other biases.
Overall assessment	High risk	High risk of bias.