Abstract
Background and Objectives: The aim of this study was to assess the association between prehospital peripheral oxygen saturation (SpO2) and intensive care unit (ICU) admission in confirmed or suspected coronavirus disease 19 (COVID-19) patients. Materials and Methods: We carried out a retrospective cohort study on patients requiring prehospital intervention between 11 March 2020 and 4 May 2020. All adult patients in whom a diagnosis of COVID-19 pneumonia was suspected by the prehospital physician were included. Patients who presented a prehospital confounding respiratory diagnosis and those who were not eligible for ICU admission were excluded. The main exposure was “Low SpO2” defined as a value < 90%. The primary outcome was 48-h ICU admission. Secondary outcomes were 48-h mortality and 30-day mortality. We analyzed the association between low SpO2 and ICU admission or mortality with univariable and multivariable regression models. Results: A total of 145 patients were included. A total of 41 (28.3%) patients had a low prehospital SpO2 and 21 (14.5%) patients were admitted to the ICU during the first 48 h. Low SpO2 was associated with an increase in ICU admission (OR = 3.4, 95% CI = 1.2–10.0), which remained significant after adjusting for sex and age (aOR = 5.2, 95% CI = 1.8–15.4). Mortality was higher in low SpO2 patients at 48 h (OR = 7.1 95% CI 1.3–38.3) and at 30 days (OR = 3.9, 95% CI 1.4–10.7). Conclusions: In our physician-staffed prehospital system, first low prehospital SpO2 values were associated with a higher risk of ICU admission during the COVID-19 pandemic.
Highlights
In December 2019, a novel coronavirus emerged in China and spread rapidly, leading to a global pandemic
Clinical knowledge regarding COVID-19 complications was scarce at the beginning of the pandemic, the “acute respiratory distress syndrome” (ARDS) being most described [2]
Several international guidelines recommend that patients requiring endotracheal intubation (ETI) or presenting a peripheral oxygen saturation (SpO2) < 90% on oxygen (O2) with persistent signs of respiratory insufficiency should be admitted to an intensive care unit (ICU) [5]
Summary
In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and spread rapidly, leading to a global pandemic. The aim of this study was to assess the association between prehospital peripheral oxygen saturation (SpO2) and intensive care unit (ICU) admission in confirmed or suspected coronavirus disease 19 (COVID-19) patients. All adult patients in whom a diagnosis of COVID-19 pneumonia was suspected by the prehospital physician were included. Patients who presented a prehospital confounding respiratory diagnosis and those who were not eligible for ICU admission were excluded. We analyzed the association between low SpO2 and ICU admission or mortality with univariable and multivariable regression models. A total of 41 (28.3%) patients had a low prehospital SpO2 and 21 (14.5%) patients were admitted to the ICU during the first 48 h. Conclusions: In our physician-staffed prehospital system, first low prehospital SpO2 values were associated with a higher risk of ICU admission during the COVID-19 pandemic
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