Jouffroy Romain, Kedzierewicz Romain, Derkenne Clement, Bertho Kilian, Scannavino Marine, Frattini Benoit, Lemoine Frederic, Jost Daniel, Prunet Bertrand
Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.
J Clin Med. 2020 Sep 20;9(9):3025. doi: 10.3390/jcm9093025.
There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting.
We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI).
We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12-0.41, < 10) with a corresponding area under curve (AUC) of 0.91 (95% CI: 0.85-0.98). HI significantly differed between patients with and without prehospital intubation (1.0 ± 1.0 vs. 3.6 ± 1.8, respectively; < 10). ROC curve analysis defined the optimal HI threshold as 1.3. Bivariate analysis revealed that HI <1.3 was significantly, positively associated with prehospital intubation (OR, 38.38; 95% CI: 11.57-146.54; < 10). Multivariate logistic regression analysis demonstrated that prehospital intubation was significantly associated with HI (adjusted odds ratio (ORa), 0.20; 95% CI: 0.06-0.45; < 10) and HI <3 (ORa, 51.08; 95% CI: 7.83-645.06; < 10). After adjustment for confounders, the ORa between HI <1.3 and prehospital intubation was 3.6 (95% CI: 1.95-5.08; < 10).
An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results.
需要有预后工具来早期识别需要在院前进行插管的新型冠状病毒肺炎（COVID-19）患者。在此，我们研究了院前低氧血症指数（HI）与COVID-19患者在院前环境中插管需求之间的关联。
我们回顾性分析了2020年3月8日至4月18日期间在院前环境中由巴黎消防队高级生命支持（ALS）团队最初护理的COVID-19患者。在倾向得分匹配后，我们使用受试者操作特征（ROC）曲线分析和逻辑回归模型分析评估HI与院前插管之间的关联。结果以比值比（OR）和95%置信区间（CI）表示。
我们分析了300例连续的COVID-19患者（166例男性（55%）；平均年龄，64±18岁）。在这些患者中，45例（15%）在现场死亡，34例（11%）有积极护理限制，18例（6%）在院前环境中进行了插管。HI的平均值为3.4±1.9。HI与院前插管显著相关（OR，0.24；95%CI：0.12 - 0.41，<0.01），相应的曲线下面积（AUC）为0.91（95%CI：0.85 - 0.98）。有和没有院前插管的患者之间HI有显著差异（分别为1.0±1.0和3.6±1.8；<0.01）。ROC曲线分析将最佳HI阈值定义为1.3。二元分析显示，HI<1.3与院前插管显著正相关（OR，38.38；95%CI：11.57 - 146.54；<0.01）。多因素逻辑回归分析表明，院前插管与HI显著相关（调整后的比值比（ORa），0.20；95%CI：0.06 - 0.45；<0.01）以及HI<3（ORa，51.08；95%CI：7.83 - 645.06；<0.01）。在对混杂因素进行调整后，HI<1.3与院前插管之间的ORa为3.6（95%CI：1.95 - 5.08；<0.01）。
HI<1.3与COVID-19患者院前插管增加3倍相关。HI可能是一种有用的工具，有助于对由巴黎消防队ALS团队最初护理的COVID-19患者进行院前插管的决策。需要进一步的前瞻性研究来证实这些初步结果。
