Abstract
Background: Best practices for management of COVID-19 patients with acute respiratory failure continue to evolve. Initial debate existed over whether patients should be intubated in the emergency department or trialed on noninvasive methods prior to intubation outside the emergency department. Objectives: To determine whether emergency department intubations in COVID-19 affect mortality. Methods: We conducted a retrospective observational chart review of patients who had a confirmed positive COVID-19 test and required endotracheal intubation during their hospital course between 1 March 2020 and 1 June 2020. Patients were divided into two groups based on location of intubation: early intubation in the emergency department or late intubation performed outside the emergency department. Clinical and demographic information was collected including comorbid medical conditions, qSOFA score, and patient mortality. Results: Of the 131 COVID-19-positive patients requiring intubation, 30 (22.9%) patients were intubated in the emergency department. No statistically significant difference existed in age, gender, ethnicity, or smoking status between the two groups at baseline. Patients in the early intubation cohort had a greater number of existing comorbidities (2.5, p = 0.06) and a higher median qSOFA score (3, p ≤ 0.001). Patients managed with early intubation had a statistically significant higher mortality rate (19/30, 63.3%) compared to the late intubation group (42/101, 41.6%). Conclusion: COVID-19 patients intubated in the emergency department had a higher qSOFA score and a greater number of pre-existing comorbidities. All-cause mortality in COVID-19 was greater in patients intubated in the emergency department compared to patients intubated outside the emergency department.
Highlights
Over the span of a few months in early 2020, the coronavirus disease 2019 (COVID-19)pandemic spread from an isolated outbreak in the city of Wuhan, China to a global catastrophe of unrivaled proportions during this century [1–3]
Thirty (22.9%) of these patients were intubated in the ED and were designated as early intubation (EI), while the remaining 101 (77.1%) were intubated elsewhere in the hospital and were designated as late intubation (LI)
2020, we found that patients intubated in the emergency department had a higher quick sequential organ failure assessment (qSOFA)
Summary
Over the span of a few months in early 2020, the coronavirus disease 2019 (COVID-19). Pandemic spread from an isolated outbreak in the city of Wuhan, China to a global catastrophe of unrivaled proportions during this century [1–3]. As the novel virus spread globally, the medical community was forced to manage critically ill patients without databased evidence for best practices. Many of the early treatment protocols for SARS-CoV-2 were devised from trial and error, theoretical calculations, or from extrapolating from previously successful therapies for treating similar pathologies [4]. The understanding of the pathophysiology and management of critically ill COVID-19 patients continues to evolve. Reported data from the initial outbreak in Wuhan, China demonstrate that older patients (age > 65 years old), patients with underlying medical conditions, and patients who develop acute respiratory distress syndrome (ARDS) have higher mortality creativecommons.org/licenses/by/ 4.0/).
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