Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

Yao, Wenlong; Wang, Tingting; Jiang, Bailing; Gao, Feng; Wang, Li; Zheng, Hongbo; Xiao, Weimin; Yao, Shanglong; Mei, Wei; Chen, Xiangdong; Luo, Ailin; Sun, Liang; Cook, Tim; Behringer, Elizabeth; Huitink, Johannes M.; Wong, David T.; Lane-Fall, Meghan; McNarry, Alistair F.; McGuire, Barry; Higgs, Andrew; Shah, Amit; Patel, Anil; Zuo, Mingzhang; Ma, Wuhua; Xue, Zhanggang; Zhang, Li-Ming; Li, Wenxian; Wang, Yong; Hagberg, Carin; O'Sullivan, Ellen P.; Fleisher, Lee A.; Wei, Huafeng

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 (Sao(2) <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 (Sao(2) <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.