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First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation.
de Alencar, Julio Cesar Garcia; Marques, Bruno; Marchini, Julio Flavio Meirelles; Marino, Lucas Oliveira; Ribeiro, Sabrina Correa da Costa; Bueno, Cauê Gasparotto; da Cunha, Victor Paro; Lazar Neto, Felippe; Valente, Fernando Salvetti; Rahhal, Hassan; Pereira, Juliana Batista Rodrigues; Padrão, Eduardo Messias Hirano; Wanderley, Annelise Passos Bispos; Costa, Millena Gomes Pinheiro; Brandão Neto, Rodrigo Antonio; Souza, Heraldo Possolo.
  • de Alencar JCG; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Marques B; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Marchini JFM; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Marino LO; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Ribeiro SCDC; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Bueno CG; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • da Cunha VP; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Lazar Neto F; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Valente FS; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Rahhal H; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Pereira JBR; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Padrão EMH; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Wanderley APB; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Costa MGP; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Brandão Neto RA; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
  • Souza HP; Emergency Department Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil.
J Am Coll Emerg Physicians Open ; 1(5): 699-705, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1898689
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.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study Language: English Journal: J Am Coll Emerg Physicians Open Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study Language: English Journal: J Am Coll Emerg Physicians Open Year: 2020 Document Type: Article