Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 12;1(5):699-705.
doi: 10.1002/emp2.12219. eCollection 2020 Oct.

First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation

Julio Cesar Garcia de Alencar  1 , Bruno Marques  1 , Julio Flavio Meirelles Marchini  1 , Lucas Oliveira Marino  1 , Sabrina Correa da Costa Ribeiro  1 , Cauê Gasparotto Bueno  1 , Victor Paro da Cunha  1 , Felippe Lazar Neto  1 , Fernando Salvetti Valente  1 , Hassan Rahhal  1 , Juliana Batista Rodrigues Pereira  1 , Eduardo Messias Hirano Padrão  1 , Annelise Passos Bispos Wanderley  1 , Millena Gomes Pinheiro Costa  1 , Rodrigo Antonio Brandão Neto  1 , Heraldo Possolo Souza  1
Affiliations

First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation

Julio Cesar Garcia de Alencar et al. J Am Coll Emerg Physicians Open. .

Abstract

Objectives: To evaluate the first-attempt success rates and complications of endotracheal intubation of coronavirus disease 2019 (COVID-19) patients by emergency physicians.

Methods: This prospective observational study was conducted from March 24, 2020 through May 28, 2020 at the emergency department (ED) of an urban, academic trauma center. We enrolled patients consecutively admitted to the ED with suspected or confirmed COVID-19 submitted to endotracheal intubation. No patients were excluded. The primary outcome was first-attempt intubation success, defined as successful endotracheal tube placement with the first device passed (endotracheal tube) during the first laryngoscope insertion confirmed with capnography. Secondary outcomes included the following complications: hypotension, hypoxemia, aspiration, and esophageal intubation.

Results: A total of 112 patients with confirmed or suspected COVID-19 were enrolled. Median age was 61 years and 61 patients (54%) were men. The primary outcome, first-attempt intubation success, was achieved in 82% of patients. Among the 20 patients who were not intubated on the first attempt, 75% were intubated on the second attempt and 20% on the third attempt; cricothyrotomy was performed in 1 patient. Forty-eight (42%) patients were hypotensive and required norepinephrine immediately post-intubation. Fifty-eight (52%) experienced peri-intubation hypoxemia, and 2 patients (2%) had cardiac arrest. There were no cases of failed intubation resulting in death up to 24 hours after the procedure.

Conclusion: Emergency physicians achieve high success rates when intubating COVID19 patients, although complications are frequent. However, these findings should be considered provisional until their generalizability is assessed in their institutions and setting.

Keywords: COVID‐19; emergency physician; intubation.

PubMed Disclaimer

References

    1. Berlin DA, Gulick RM, Martinez FJ. Severe COVID‐19. New Engl J Med. 2020. Published online May 15, 2020. - PubMed
    1. Brown CA, Mosier JM, Carlson JN, et al. Pragmatic recommendations for intubating critically ill patients with suspected COVID‐19. JACEP Open. 2020;1(2):80‐84. - PMC - PubMed
    1. Bernhard M, Bax SN, Hartwig T, et al. Airway management in the emergency department (The OcEAN‐Study) ‐ a prospective single centre observational cohort study. Scand J Trauma Resusc Emerg Med. 2019;27:20. - PMC - PubMed
    1. Mosier JM, Sakles JC, Law JA, et al. Tracheal intubation in the critically ill. Where we came from and where we should go. Am J Respir Crit Care Med. 2020;201(7):775‐788. - PubMed
    1. De Jong A, Rolle A, Molinari N, et al. Cardiac arrest and mortality related to intubation procedure in critically ill adult patients: a multicenter cohort study. Crit Care Med. 2018;46:532‐539. - PubMed