Trends in endotracheal intubation for patients with COVID-19 by emergency physicians

Abstract

Emergency physicians perform endotracheal intubations for patients with COVID-19. However, the trends in the intubation for COVID-19 patients in terms of success rate, complications, personal protective equipment (PPE) information, barrier enclosure use, and its transition have not been established. We conducted a retrospective study of COVID-19 cases that required tracheal intubation at four hospitals in the Tokyo metropolitan area between January 2020 and August 2021. The overall intubation success rate, operator experience, and infection control methods were investigated. We then compared the early and late phases of the pandemic for a period of 8 months each. A total of 211 cases met the inclusion criteria, and 133 were eligible for analysis. The intubation success rate increased from 85% to 94% from early to late phase, although the percentage of intubations performed by emergency medicine residents increased significantly in the late phase (p = 0.03). The percentage of light PPE use significantly increased from 65% to 91% from early to late phase (p < 0.01), whereas the percentage of barrier enclosure use significantly decreased from 26% to 0% (p < 0.01). Furthermore, the infection prevention methods during intubation became more simplified from early to late phase.

Intubation practices and outcomes for patients with suspected or confirmed COVID-19: a national observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN)

“…High rates of first-pass success among patients with and without SARS-CoV-2 are consistent with first-pass success rates from resource-rich settings, [4][5][6][7] and notably better than first-pass success rates globally prior to the onset of the COVID-19 pandemic [14]. Existing published reports of intubation processes and outcomes during the COVID-19 pandemic are limited to small single-centre studies [15][16][17][18][19][20][21]. Of these, only two studies described intubations performed exclusively by emergency physicians with first-pass-success rates ranging from 82% [16] to 91% [19].…”

“…Existing published reports of intubation processes and outcomes during the COVID-19 pandemic are limited to small single-centre studies [15][16][17][18][19][20][21]. Of these, only two studies described intubations performed exclusively by emergency physicians with first-pass-success rates ranging from 82% [16] to 91% [19]. In early studies during the COVID-19 pandemic fewer intubators were emergency physicians (as compared to anesthesiologists or critical care medicine physicians), and first-pass-success ranged from 86% [17] to 89% [18].…”

A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

“…It was reported that VL "should be dedicated for use in patients with COVID-19, where this is feasible, and disposable VL blades are preferred" [153]. In reality, for practical reasons, DL was still used in certain cases during the COVID-19 pandemic [154][155][156].…”

Controversies Concerning Emergency Tracheal Intubation in Patients with COVID-19

“…The types of PPE have been changed for many reasons, and the infection prevention methods during intubation have become more simplified from the early to late phases of the pandemic. 2,5,11,12 The percentage of lower levels of PPE use significantly increased. 12 The recommendation 5 for the highest level of PPE during emergent tracheal intubation subsided.…”

“…2,5,11,12 The percentage of lower levels of PPE use significantly increased. 12 The recommendation 5 for the highest level of PPE during emergent tracheal intubation subsided. Level II PPE, characterized by eye protection and respirators, is currently pragmatic.…”