Endotracheal Intubation Strategy, Success, and Adverse Events Among Emergency Department Patients During the COVID-19 Pandemic - 19/01/23
, Eliezer Santos Leon, MS, MPH a, Jestin N. Carlson, MD d, Brian Driver, MD e, Anusha Krishnadasan, PhD f, Karisa K. Harland, PhD, MPH a, c, Patrick Ten Eyck, PhD g, William R. Mower, MD, PhD h, Tyler M. Foley, MD i, Kelli Wallace, MS a, L. Clifford McDonald, MD j, Preeta K. Kutty, MD, MPH j, Scott Santibanez, MD, MPHTM k, David A. Talan, MD a, f, hProject COVERED Emergency Department Network
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Abstract |
Study objective |
To describe endotracheal intubation practices in emergency departments by staff intubating patients early in the coronavirus disease 2019 (COVID-19) pandemic.
Methods |
Multicenter prospective cohort study of endotracheal intubations conducted at 20 US academic emergency departments from May to December 2020, stratified by known or suspected COVID-19 status. We used multivariable regression to measure the association between intubation strategy, COVID-19 known or suspected status, first-pass success, and adverse events.
Results |
There were 3,435 unique emergency department endotracheal intubations by 586 participating physicians or advanced practice providers; 565 (18%) patients were known or suspected of having COVID-19 at the time of endotracheal intubation. Compared with patients not known or suspected of COVID-19, endotracheal intubations of patients with known or suspected COVID-19 were more often performed using video laryngoscopy (88% versus 82%, difference 6.3%; 95% confidence interval [CI], 3.0% to 9.6%) and passive nasal oxygenation (44% versus 39%, difference 5.1%; 95% CI, 0.9% to 9.3%). First-pass success was not different between those who were and were not known or suspected of COVID-19 (87% versus 86%, difference 0.6%; 95% CI, –2.4% to 3.6%). Adjusting for patient characteristics and procedure factors in those with low anticipated airway difficulty (n=2,374), adverse events (most commonly hypoxia) occurred more frequently in patients with known or suspected COVID-19 (35% versus 19%, adjusted odds ratio 2.4; 95% CI, 1.7 to 3.3).
Conclusion |
Compared with patients not known or suspected of COVID-19, endotracheal intubation of those confirmed or suspected to have COVID-19 was associated with a similar first-pass intubation success rate but higher risk-adjusted adverse events.
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| Please see page 146 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: NMM and DAT were responsible for conceptualization, study design, data interpretation, drafting the manuscript, project administration, funding acquisition. ESL, KKH, and PT were responsible for data management, data analysis, interpretation, and revising the manuscript for important intellectual content. JNC and BD were responsible for conceptualization, data interpretation, and revising the manuscript for important intellectual content. AK was responsible for data management, study coordination, and revising the manuscript for important intellectual content. WRM was responsible for conceptualization, study design, interpretation of the data analysis, and revising the manuscript for important intellectual content. TMF was responsible for data interpretation and drafting a portion of the manuscript. KW was responsible for data management, study coordination, and revising the manuscript for important intellectual content. CM, PKK, and SS were responsible for conceptualization, acquisition of funding, data interpretation, and revising the manuscript for important intellectual content. NMM takes ultimate responsibility for the integrity of the data, and all authors approved the final manuscript prior to publication. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This project was funded by a cooperative agreement from the Centers for Disease Control and Prevention (U01CK000480) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. |
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Vol 81 - N° 2
P. 145-157 - février 2023 Retour au numéro
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