Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients

Jouffroy, Romain; Kedzierewicz, Romain; Derkenne, Clément; Bertho, Kilian; Scannavino, Marine; Frattini, Benoît; Lemoine, Frédéric; Jost, Daniel; Prunet, Bertrand

doi:10.3390/jcm9093025

Cited by 7 publications

(5 citation statements)

References 48 publications

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“…While SpO 2 should be interpreted with caution due to the leftward shift in the oxyhemoglobin dissociation curve linked to respiratory alkalosis, it remains a simple means often used to detect hypoxemia [15]. Given the prognostic importance of timely therapeutic and orientation decisions, our study supports the use of pulse oximetry as part of rapid assessment in the event of a massive influx of COVID-19 patients [8,14].…”

Section: Discussionsupporting

confidence: 56%

“…Prehospital SpO2 values lower than 90% are, nevertheless, generally correlated with respiratory deterioration over time [2,15]. Such patients are therefore at increased risk of sudden worsening, requiring ETI and ICU admission [8,15]. Accordingly, we found that patients who belonged to the "Low SpO2" patient group had higher respiratory rates and higher prehospital gravity scores than those who belonged to the "Normal SpO2" group.…”

Section: Discussionmentioning

confidence: 61%

“…Even though most COVID-19 patients taken care of by prehospital providers do not require advanced respiratory care at first, about 5% of COVID-19 cases present a rapid worsening of their respiratory status and require invasive ventilatory support either in the prehospital setting or upon arrival at the hospital [7][8][9]. Early identification of these patients can help spare ED resources.…”

Section: Introductionmentioning

confidence: 99%

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Association between Prehospital Hypoxemia and Admission to Intensive Care Unit during the COVID-19 Pandemic: A Retrospective Cohort Study

et al. 2021

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Background and Objectives: The aim of this study was to assess the association between prehospital peripheral oxygen saturation (SpO2) and intensive care unit (ICU) admission in confirmed or suspected coronavirus disease 19 (COVID-19) patients. Materials and Methods: We carried out a retrospective cohort study on patients requiring prehospital intervention between 11 March 2020 and 4 May 2020. All adult patients in whom a diagnosis of COVID-19 pneumonia was suspected by the prehospital physician were included. Patients who presented a prehospital confounding respiratory diagnosis and those who were not eligible for ICU admission were excluded. The main exposure was “Low SpO2” defined as a value < 90%. The primary outcome was 48-h ICU admission. Secondary outcomes were 48-h mortality and 30-day mortality. We analyzed the association between low SpO2 and ICU admission or mortality with univariable and multivariable regression models. Results: A total of 145 patients were included. A total of 41 (28.3%) patients had a low prehospital SpO2 and 21 (14.5%) patients were admitted to the ICU during the first 48 h. Low SpO2 was associated with an increase in ICU admission (OR = 3.4, 95% CI = 1.2–10.0), which remained significant after adjusting for sex and age (aOR = 5.2, 95% CI = 1.8–15.4). Mortality was higher in low SpO2 patients at 48 h (OR = 7.1 95% CI 1.3–38.3) and at 30 days (OR = 3.9, 95% CI 1.4–10.7). Conclusions: In our physician-staffed prehospital system, first low prehospital SpO2 values were associated with a higher risk of ICU admission during the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Association between Prehospital Hypoxemia and Admission to Intensive Care Unit during the COVID-19 Pandemic: A Retrospective Cohort Study

et al. 2021

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“… Mental Health 18 Jouffroy et. al 31 Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients Case Control Clinical care reports of COVID-19 patients cared for by regional ALS prehospital service Paris, FR ● A hypoxemia index (HI) < 1.3 correlated with a 3 fold increase in prehospital endotracheal intubation of patients with COVID-19. ● Hypoxemia index may be a reliable indicator for prehospital endotracheal intubation in respiratorily compromised patients with COVID-19.…”

Section: Resultsmentioning

confidence: 99%

Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review

Ventura¹,

Denton²,

David³

et al. 2022

OAEM

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This study aimed to analyze prehospital Emergency Medical Services (EMS) response to the COVID-19 pandemic in the US through a brief systematic review of available literature in context with international prehospital counterparts. An exploration of the NCBI repository was performed using a search string of relevant keywords which returned n=5128 results; articles that met the inclusion criteria (n=77) were reviewed and analyzed in accordance with PRISMA and PROSPERO recommendations. Methodical quality was assessed using critical appraisal tools, and the Egger’s test was used for risk of bias reduction upon linear regression analysis of a funnel plot. Sources of heterogeneity as defined by P < 0.10 or I^2 > 50% were interrogated. Findings were considered within ten domains: structural/systemic; clinical outcomes; clinical assessment; treatment; special populations; dispatch/activation; education; mental health; perspectives/experiences; and transport. Findings suggest, EMS clinicians have likely made significant and unmeasured contributions to care during the pandemic via nontraditional roles, ie, COVID-19 testing and vaccine deployment. EMS plays a critical role in counteracting the COVID-19 pandemic in addition to the worsening opioid epidemic, both of which disproportionately impact patients of color. As such, being uniquely influential on clinical outcomes, these providers may benefit from standardized education on care and access disparities such as racial identity. Access to distance learning continuing education opportunities may increase rates of provider recertification. Additionally, there is a high prevalence of vaccine hesitancy among surveyed nationally registered EMS providers. Continued rigorous investigation on the impact of COVID-19 on EMS systems and personnel is warranted to ensure informed preparation for future pandemic and infectious disease responses.

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“…In the prehospital setting, endotracheal intubation may be required to secure a patient’s airways is some of the cases. In Paris, out of 300 consecutive COVID-19 patients, 18 (6%) were treated by endotracheal intubation by the Paris Fire Brigade Advanced Life Support teams [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study

et al. 2021

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Background In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier. Methods A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants’ performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively. Results There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015). Conclusions The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.

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Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients

Cited by 7 publications

References 48 publications

Association between Prehospital Hypoxemia and Admission to Intensive Care Unit during the COVID-19 Pandemic: A Retrospective Cohort Study

Association between Prehospital Hypoxemia and Admission to Intensive Care Unit during the COVID-19 Pandemic: A Retrospective Cohort Study

Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review

Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study

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