Ap-Ox Works – New Meta-analyses

August 10, 2017

Spoon Feed
Blasting nasal cannula oxygen (apneic oxygenation) during endotracheal intubation of ED patients led to higher O2 saturation, decreased episodes of desaturation, and improved first-pass success.

Why does this matter?
Hypoxia during intubation is associated with increased mortality.  There have been conflicting studies about whether or not apneic oxygenation really works to reduce hypoxia.  Combining these studies showed that apneic oxygenation was effective.

Blast it in there
This was a meta-analysis of 8 studies of apneic oxygenation, including 1837 patients.  This was a mix of RCTs and observational studies of variable quality in both the ED and ICU settings.  Most used very high flow humidified NC at 60-70L/min, though some used standard 15L/min.  They found use of apneic oxygenation led to higher overall oxygen saturation (2.2% higher), decreased desaturation, no change in severe desaturation, and improved first-pass success (59% greater odds; OR 1.59, 95%CI 1.04-2.44).  Note, a similar meta-analysis was published in AJEM this month as well, with similar findings.  The main difference was the AJEM study included only cohorts using NC 15L/min and found decreased critical desaturation; they also found improved first-pass success, though not quite as marked as in this analysis.

Source
Effectiveness of Apneic Oxygenation During Intubation: A Systematic Review and Meta-analysis  Ann Emerg Med. 2017 Jul 13. pii: S0196-0644(17)30582-6. doi: 10.1016/j.annemergmed.2017.05.001. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.