Department of Emergency Medicine, Vancouver General Hospital and the University of British Columbia, Vancouver, BC, Canada.
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
CJEM. 2021 Jul;23(4):512-517. doi: 10.1007/s43678-020-00061-z. Epub 2021 Jan 11.
The Covid-19 pandemic has required new protocols for endotracheal intubation mandating cumbersome personal protective equipment and modifications to prior intubation procedures. We assessed the success and complications of endotracheal intubation under such protocols.
We conducted a prospective study of endotracheal intubation in the emergency department, intensive care unit, or ward between September 11, 2018 and June 11, 2020 at two urban hospitals. Using a standardized form, we included basic demographics, intubation techniques, and success, and pre-specified complications, defined as critical (cardiac arrest or failure to intubate) or non-critical. At both sites, Covid-19 intubation protocols took effect on March 11, 2020, and we compared pre-post patients. The primary outcome was first-pass success without complications. Secondary outcomes included first-pass success and complications. We analysed by descriptive techniques.
Overall, we collected 1534 patients before March 11, 2020 and 227 after; groups were similar in age and sex distribution. Staff endotracheal intubation increased from 37 to 63%. First pass success was 1262/1534 (82.3%) pre versus 195/227 (85.9%) post, for a difference of 3.6% (95% CI - 1.8-8.0%). First pass success without complications was 1116/1534 (72.8%) pre versus 168/227 (74.0%) post, for a difference of 1.3%, (95% CI - 5.2-7.0%). There were 226 complications pre (14.7%) versus 47 (20.7%) post, for a difference of 6.0%. (95% CI 0.6-12.1%).
New pandemic endotracheal intubation protocols did not result in a decrease in first-pass success, or first-pass success without complications.
Covid-19 大流行要求新的气管插管协议，规定使用繁琐的个人防护设备，并修改先前的插管程序。我们评估了在这些协议下进行气管插管的成功率和并发症。
我们在 2018 年 9 月 11 日至 2020 年 6 月 11 日在两家城市医院的急诊科、重症监护室或病房进行了一项前瞻性气管插管研究。使用标准化表格，我们包括了基本人口统计学、插管技术以及成功和预先指定的并发症，定义为危急（心脏骤停或插管失败）或非危急。在这两个地点，Covid-19 插管协议于 2020 年 3 月 11 日生效，我们比较了前后患者。主要结局是无并发症的首次通过成功率。次要结局包括首次通过成功率和并发症。我们通过描述性技术进行分析。
总体而言，我们在 2020 年 3 月 11 日之前收集了 1534 名患者，之后收集了 227 名患者；两组在年龄和性别分布上相似。医护人员的气管插管从 37%增加到 63%。首次通过成功率为 1534 例中的 1262 例（82.3%）前与 227 例中的 195 例（85.9%）后，差异为 3.6%（95%CI-1.8-8.0%）。无并发症的首次通过成功率为 1534 例中的 1116 例（72.8%）前与 227 例中的 168 例（74.0%）后，差异为 1.3%（95%CI-5.2-7.0%）。前有 226 例并发症（14.7%）与后有 47 例并发症（20.7%），差异为 6.0%（95%CI0.6-12.1%）。
新的大流行气管插管协议并未导致首次通过成功率或无并发症的首次通过成功率下降。
