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. 2021 Jul 20;22(4):979-987.
doi: 10.5811/westjem.2021.3.50116.

Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress

Zachary J Jarou  1 , David G Beiser  1 , Willard W Sharp  1 , Ravi Chacko  1 , Deirdre Goode  1 , Daniel S Rubin  2 , Dinesh Kurian  2 , Allison Dalton  2 , Stephen R Estime  2 , Michael O'Connor  2 , Bhakti K Patel  3 , John P Kress  3 , Thomas F Spiegel  1
Affiliations

Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress

Zachary J Jarou et al. West J Emerg Med. .

Abstract

Introduction: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay.

Methods: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol.

Results: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts.

Conclusions: The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Drs. Jarou, Beiser, Chako, Goode, Dalton, Kurian, Kress, Estime, and Spiegel have nothing to disclose. Dr. Sharp reports a grant from the National Institutes of Health (R01 HL133675). Dr. Rubin reports serving as the President of DRDR Mobile Health and receiving compensation for expert witness testimony for the U.S. Department of Justice. Dr. Patel reports receiving a career development grant from the Parker B. Francis Foundation. Dr. O’Connor reports receiving equity for serving on the Scientific Advisory Board of CLEW. There are no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of patient screening, eligibility, inclusion, exclusion. ED, emergency department; ETT, endotracheal intubation; HFNC, high-flow nasal cannula.
See this image and copyright information in PMC

References

    1. Goh KH, Kalimuddin S, Chan KS. Rapid progression to acute respiratory distress syndrome: review of current understanding of critical illness from coronavirus disease 2019 (COVID-19) infection. Ann Acad Med Singapore. 2020;49:108–10. - PubMed
    1. Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology. 2020;132:1317–32. - PMC - PubMed
    1. Hui DS, Chow BK, Lo T. Exhaled air dispersion during high flow nasal cannula therapy versus CPAP via different masks. Eur Respir J. 2019;53(4):1802339. - PubMed
    1. Li J, Fink JB, Ehrmann S. High-flow nasal cannula for COVID-19 patients: low risk of bio-aerosol dispersion. Eur Respir J. 2020;55(5):2000892. - PMC - PubMed
    1. Loh NHW, Tan Y, Taculod J. The impact of high-flow nasal cannula (HFNC) on coughing distance: implications on its use during the novel coronavirus disease outbreak. Can J Anesth. 2020;67:893–4. - PMC - PubMed