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 *
| 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 |
*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; aOR adjusted Odds Ratio; aHR adjusted Hazard Ratios; NR not reported; CI confidence interval; RR risk ratio; IRR incidence rate ratio; PR prevalence ratio
aUnadjusted Odds Ratio unless otherwise specified
bAdjusted Odds Ratios of SARS-CoV-2 seroconversion reported because unadjusted odds ratios could not be found
cAdjusted Hazard Ratios of SARS-CoV-2 PCR/rapid antigen tests reported because unadjusted odds ratios could not be found
dAGMP status of comparator unclear
eAGMP with systematic use of FFP2 compared to non-AGMP exposure
fAGMP without systematic use of FFP2 compared to non-AGMP exposure