Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

TY - JOUR

T1 - Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China

T2 - lessons learnt and international expert recommendations

AU - Yao, Wenlong

AU - Wang, Tingting

AU - Jiang, Bailing

AU - Gao, Feng

AU - Wang, Li

AU - Zheng, Hongbo

AU - Xiao, Weimin

AU - Yao, Shanglong

AU - Mei, Wei

AU - Chen, Xiangdong

AU - Luo, Ailin

AU - Sun, Liang

AU - Cook, Tim

AU - Behringer, Elizabeth

AU - Huitink, Johannes M.

AU - Wong, David T.

AU - Lane-Fall, Meghan

AU - McNarry, Alistair F.

AU - McGuire, Barry

AU - Higgs, Andrew

AU - Shah, Amit

AU - Patel, Anil

AU - Zuo, Mingzhang

AU - Ma, Wuhua

AU - Xue, Zhanggang

AU - Zhang, Li Ming

AU - Li, Wenxian

AU - Wang, Yong

AU - Hagberg, Carin

AU - O'Sullivan, Ellen P.

AU - Fleisher, Lee A.

AU - Wei, Huafeng

AU - Peng, Zhiyong

AU - Liang, Hansheng

AU - Nishikawa, Koji

PY - 2020/7

Y1 - 2020/7

N2 - Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (SaO2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (SaO2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.

AB - Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (SaO2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (SaO2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.

KW - ARDS

KW - COVID-19

KW - airway management

KW - consensus recommendations

KW - critical care

KW - infection prevention and control

KW - pneumonia

KW - respiratory failure

KW - tracheal intubation

UR - https://www.scopus.com/pages/publications/85083290125

U2 - 10.1016/j.bja.2020.03.026

DO - 10.1016/j.bja.2020.03.026

M3 - Article

C2 - 32312571

AN - SCOPUS:85083290125

SN - 0007-0912

VL - 125

SP - e28-e37

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 1

ER -