Does intubation of COVID-19 patients save lives? a descriptive analysis of a prospective registry

ABSTRACT

INTRODUCTION: As the COVID-19 pandemic continues, respiratory management strategies emerged as a primary concern. The mortality rate for patients with COVID19 who require intubation, and the predictors of mortality for this specific population are poorly characterized with only a few case series and retrospective studies. Published mortality rates of patients requiring intubation have ranged from as low as 35% to as high as 80%. Given the overall high mortality rate associate with intubation, growing literature calls for further efforts to characterize this critical population. METHODS: Analysis of a single urban academic center prospective database of intubated patients with COVID-19, including transferred patients. Descriptive statistics were used to characterize the intubated patients. Logistic regression was performed to account for age, gender, BMI, race, history of diabetes, COPD, and asthma. RESULTS: From March 2020 to July 2020, 369 COVID-19 patients were included in the registry 93 of whom were intubated. Of those intubated, mean age was 57.3 years, with an average BMI of 32.5. 63.7% of the intubated patients were males, with 62.6% Black, 24.2% Hispanic, and 13.2% Caucasian. We report an overall mortality of 80%, with a crude odds ratio of 28.5 (95% CI 14.5 - 55.8) for death associated with intubation. Logistic modeling revealed that age and gender are significantly associated with mortality, with mortality odds increasing approximately 9% for each year of age, and 2.8 times higher for males. BMI, race, and history of diabetes, COPD, and asthma did not meet statistical significance for association with mortality, nor were there any significant interaction effects. Holding age and gender constant, the odds ratio for death associated with intubation increases to 105.3 (95% CI 38.5-287.8). CONCLUSIONS: We report a high mortality rate of intubated patients, which may be multifactorial from being a referral center accepts critically ill patients, including evaluation for ECMO. Furthermore, our institution was an early adopter of noninvasive ventilation methods in an attempt to avoid intubation whenever possible. Ultimately, further studies are needed to better characterize those COVID-19 patients that require intubation and what variables are more closely associated with morbidity and mortality.