TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Endotracheal intubation is performed to secure the airway for various elective and emergent indications, including surgeries, respiratory failure, and altered mental status1. Currently, the supine position is the most common position used for endotracheal intubation2. Intubations in the non-supine position can be necessary in many situations, including patients with back pain/lesions, increased aspiration risk, dislodgement of the endotracheal tube during surgery in the lateral position, amongst various other indications3–5. Experience in intubation in the non-supine position is vital as inadequate airway management in these circumstances can be catastrophic, leading to hypoxia, brain injury, and even death6. METHODS: We performed a comprehensive literature search of major databases from inception to July 2020. The primary outcomes assessed were the success rate in supine vs. non-supine intubation and success rate from 1st intubation attempt. The secondary outcomes assessed were the overall adverse events. Pooled estimates were calculated using random-effects models with 95% confidence interval (C.I.). The statistical analysis was done using STATA v16.1 software (StataCorp, LLC College Station, TX). RESULTS: Our final analysis included 13 clinical trials with 1,916 patients. The pooled success rates in the supine vs lateral positions were 99.21% (95% CI 97.92-99.95, I2=0.0% p=0.87), and 98.82% (95% CI 97.47-99.75, I2=0.0% p=0.60), respectively. The pooled success rates in the supine vs semi-erect position were 99.21% (95% CI 97.92-99.95, I2=0.0% p=0.81), and 98.82% (95% CI 97.47-99.75, I2=0.0% p=0.49), respectively. The pooled 1st attempt success rate in the supine vs lateral position was 85.35% (95% CI 65.80-97.83, I2= 94.98%, p=0.00) and 88.56% (95% CI 81.76-94.03, 91.37% p=0.00), respectively as compared to 91.38% (95% CI 78.89-98.93, I2= p=0.00) and 90.76% (95% CI 77.31-98.86, I2=85.49% p=0.00) for supine vs semi-erect position respectively. The pooled rate of total adverse events in supine position was 3.73% (95% CI 0.51-8.91, I2=64.93%, p=0.01) vs 6.74% (95% CI 2.03-13.45, I2=77.90%, p=0.00) in lateral position and the pooled rate of total adverse events in supine position was 0.44% (95% CI 0.00-4.58, I2=72.96, p=0.01) vs 0.93% (95% CI 0.00-7.07, I2=83.59%, p=0.00), and in semi-erect position. Low to substantial heterogeneity was noted in our analysis. CONCLUSIONS: Our systematic review and meta-analysis demonstrates no significant difference between total successful intubations and success from 1st intubation attempt between supine and non-supine positions. It also showed slightly higher rates of adverse in non-supine position as compared to supine position. CLINICAL IMPLICATIONS: Endotracheal intubation in non-supine intubation is a safe procedure with high success rate and low risk of adverse events. DISCLOSURES: No relevant relationships by Yussef Al Ghoul, source=Web Response No relevant relationships by Tareq Arar, source=Web Response No relevant relationships by Banreet Dhindsa, source=Web Response No relevant relationships by Rajany Dy, source=Web Response No relevant relationships by Rajkamal Hansra, source=Web Response No relevant relationships by Marwan Mashina, source=Web Response No relevant relationships by Radwan Mashina, source=Web Response