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Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations.
Br J Anaesth. 2020 07; 125(1):e28-e37.BJ

Abstract

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.

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Authors+Show Affiliations

Yao W
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Wang T
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Jiang B
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
Gao F
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Wang L
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Zheng H
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Xiao W
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Yao S
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Mei W
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Chen X
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: Xiangdongchen2013@163.com.
Luo A
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: alluo@tjh.tjmu.edu.cn.
Sun L
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
Cook T
Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
Behringer E
Division of Cardiovascular Surgery and Critical Care, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Huitink JM
Airway Management Academy, Amsterdam, the Netherlands.
Wong DT
Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Lane-Fall M
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
McNarry AF
Department of Anaesthesia, Western General Hospital, Edinburgh, UK.
McGuire B
Department of Anaesthesia, Ninewells Hospital, Dundee, UK.
Higgs A
Department of Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals, Warrington, UK.
Shah A
Department of Anesthesiology, Kailash Cancer Hospital and Research Center, Muni Seva Ashram, Goraj, India.
Patel A
Department of Anaesthesiology, Royal National Throat, Nose and Ear Hospital, London, UK.
Zuo M
Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Ma W
Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.
Xue Z
Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Zhang LM
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center (UPMC) and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Li W
Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China.
Wang Y
Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.
Hagberg C
Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
O'Sullivan EP
Department of Anaesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland.
Fleisher LA
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
Wei H
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: huafeng.wei@pennmedicine.upenn.edu.
collaborators
No affiliation info available

MeSH

AgedBetacoronavirusCOVID-19ChinaCoronavirus InfectionsFemaleHumansHypotensionHypoxiaIntubation, IntratrachealMalePandemicsPersonal Protective EquipmentPneumonia, ViralPneumothoraxPractice Guidelines as TopicRetrospective StudiesSARS-CoV-2

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

32312571

Clinical Trial Links

Coronavirus Associated Pneumomediastinum and Pneumothorax
Tracheal Intubation in COVID-19 Patients

Citation

Yao, Wenlong, et al. "Emergency Tracheal Intubation in 202 Patients With COVID-19 in Wuhan, China: Lessons Learnt and International Expert Recommendations." British Journal of Anaesthesia, vol. 125, no. 1, 2020, pp. e28-e37.
Yao W, Wang T, Jiang B, et al. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth. 2020;125(1):e28-e37.
Yao, W., Wang, T., Jiang, B., Gao, F., Wang, L., Zheng, H., Xiao, W., Yao, S., Mei, W., Chen, X., Luo, A., Sun, L., Cook, T., Behringer, E., Huitink, J. M., Wong, D. T., Lane-Fall, M., McNarry, A. F., McGuire, B., ... Wei, H. (2020). Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. British Journal of Anaesthesia, 125(1), e28-e37. https://doi.org/10.1016/j.bja.2020.03.026
Yao W, et al. Emergency Tracheal Intubation in 202 Patients With COVID-19 in Wuhan, China: Lessons Learnt and International Expert Recommendations. Br J Anaesth. 2020;125(1):e28-e37. PubMed PMID: 32312571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. AU - Yao,Wenlong, AU - Wang,Tingting, AU - Jiang,Bailin, AU - Gao,Feng, AU - Wang,Li, AU - Zheng,Hongbo, AU - Xiao,Weimin, AU - Yao,Shanglong, AU - Mei,Wei, AU - Chen,Xiangdong, AU - Luo,Ailin, AU - Sun,Liang, AU - Cook,Tim, AU - Behringer,Elizabeth, AU - Huitink,Johannes M, AU - Wong,David T, AU - Lane-Fall,Meghan, AU - McNarry,Alistair F, AU - McGuire,Barry, AU - Higgs,Andrew, AU - Shah,Amit, AU - Patel,Anil, AU - Zuo,Mingzhang, AU - Ma,Wuhua, AU - Xue,Zhanggang, AU - Zhang,Li-Ming, AU - Li,Wenxian, AU - Wang,Yong, AU - Hagberg,Carin, AU - O'Sullivan,Ellen P, AU - Fleisher,Lee A, AU - Wei,Huafeng, AU - ,, Y1 - 2020/04/10/ PY - 2020/03/27/received PY - 2020/03/31/revised PY - 2020/03/31/accepted PY - 2020/4/22/pubmed PY - 2020/7/4/medline PY - 2020/4/22/entrez KW - ARDS KW - COVID-19 KW - airway management KW - consensus recommendations KW - critical care KW - infection prevention and control KW - pneumonia KW - respiratory failure KW - tracheal intubation SP - e28 EP - e37 JF - British journal of anaesthesia JO - Br J Anaesth VL - 125 IS - 1 N2 - Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/32312571/Emergency_tracheal_intubation_in_202_patients_with_COVID_19_in_Wuhan_China:_lessons_learnt_and_international_expert_recommendations_ DB - PRIME DP - Unbound Medicine ER -