Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
Rady Faculty of Health Sciences, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
CJEM. 2023 Apr;25(4):335-343. doi: 10.1007/s43678-023-00487-1. Epub 2023 Apr 5.
Intubation practices changed during the COVID-19 pandemic to protect healthcare workers from transmission of disease. Our objectives were to describe intubation characteristics and outcomes for patients tested for SARS CoV-2 infection. We compared outcomes between patients testing SARS COV-2 positive with those testing negative.
We conducted a health records review using the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. We included consecutive eligible patients who presented to one of 47 EDs across Canada between March 1, 2020 and June 20, 2021, were tested for SARS-CoV-2 and intubated in the ED. The primary outcome was the proportion of patients experiencing a post-intubation adverse event during the ED stay. Secondary outcomes included first-pass success, intubation practices, and hospital mortality. We used descriptive statistics to summarize variables with subgroup differences examined using t tests, z tests, or chi-squared tests where appropriate with 95% CIs.
Of 1720 patients with suspected COVID-19 who were intubated in the ED during the study period, 337 (19.6%) tested SARS-CoV-2 positive and 1383 (80.4%) SARS-CoV-2 negative. SARS-CoV-2 positive patients presented to hospital with lower oxygen levels than SARS-CoV-2 negative patients (mean pulse oximeter SaO2 86 vs 94%, p < 0.001). In total, 8.5% of patients experienced an adverse event post-intubation. More patients in the SARS-CoV-2 positive subgroup experienced post-intubation hypoxemia (4.5 vs 2.2%, p = 0.019). In-hospital mortality was greater for patients who experienced intubation-related adverse events (43.2 vs 33.2%, p = 0.018). There was no significant difference in adverse event-associated mortality by SARS-CoV-2 status. First-pass success was achieved in 92.4% of all intubations, with no difference by SARS-CoV-2 status.
During the COVID-19 pandemic, we observed a low risk of adverse events associated with intubation, even though hypoxemia was common in patients with confirmed SARS-CoV-2. We observed high rates of first-pass success and low rates of inability to intubate. The limited number of adverse events precluded multivariate adjustments. Study findings should reassure emergency medicine practitioners that system modifications made to intubation processes in response to the COVID-19 pandemic do not appear to be associated with worse outcomes compared to pre-COVID-19 practices.
在 COVID-19 大流行期间，为了防止医护人员传播疾病，插管操作发生了变化。我们的目标是描述接受 SARS-CoV-2 感染检测患者的插管特征和结局。我们比较了 SARS-CoV-2 检测阳性患者与阴性患者的结局。
我们使用加拿大 COVID-19 急诊科快速反应网络（CCEDRRN）注册表进行了病历回顾。我们纳入了 2020 年 3 月 1 日至 2021 年 6 月 20 日期间在加拿大 47 家急诊科连续就诊且接受 SARS-CoV-2 检测并在急诊科进行插管的符合条件的患者。主要结局是 ED 住院期间经历插管后不良事件的患者比例。次要结局包括首次插管成功率、插管操作和住院死亡率。我们使用描述性统计方法总结变量，使用 t 检验、z 检验或适当的卡方检验比较亚组差异，95%CI。
在研究期间接受 ED 插管的 1720 例疑似 COVID-19 患者中，337 例（19.6%）SARS-CoV-2 检测阳性，1383 例（80.4%）SARS-CoV-2 检测阴性。与 SARS-CoV-2 阴性患者相比，SARS-CoV-2 阳性患者入院时的氧饱和度较低（平均脉搏血氧仪 SaO2 86% vs 94%，p<0.001）。总的来说，8.5%的患者经历了插管后不良事件。SARS-CoV-2 阳性亚组中更多患者发生插管后低氧血症（4.5% vs 2.2%，p=0.019）。发生与插管相关不良事件的患者住院死亡率更高（43.2% vs 33.2%，p=0.018）。SARS-CoV-2 状态与不良事件相关死亡率无显著差异。所有插管中首次插管成功率达到 92.4%，与 SARS-CoV-2 状态无关。
在 COVID-19 大流行期间，即使在确诊 SARS-CoV-2 患者中普遍存在低氧血症的情况下，我们也观察到与插管相关的不良事件风险较低。我们观察到首次插管成功率高，无法插管的发生率低。不良事件数量有限，无法进行多变量调整。研究结果应该让急诊医学从业者放心，针对 COVID-19 大流行对插管过程进行的系统修改似乎与 COVID-19 前的实践相比，不会导致更差的结局。
