• Nicholas M Mohr, Eliezer Santos Leon, Jestin N Carlson, Brian Driver, Anusha Krishnadasan, Karisa K Harland, Patrick Ten Eyck, William R Mower, Tyler M Foley, Kelli Wallace, L Clifford McDonald, Preeta K Kutty, Scott Santibanez, David A Talan, and Project COVERED Emergency Department Network.
• Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA. Electronic address: nicholas-mohr@uiowa.edu.
• Ann Emerg Med. 2023 Feb 1; 81 (2): 145157145-157.

Study ObjectiveTo describe endotracheal intubation practices in emergency departments by staff intubating patients early in the coronavirus disease 2019 (COVID-19) pandemic.MethodsMulticenter prospective cohort study of endotracheal intubations conducted at 20 US academic emergency departments from May to December 2020, stratified by known or suspected COVID-19 status. We used multivariable regression to measure the association between intubation strategy, COVID-19 known or suspected status, first-pass success, and adverse events.ResultsThere were 3,435 unique emergency department endotracheal intubations by 586 participating physicians or advanced practice providers; 565 (18%) patients were known or suspected of having COVID-19 at the time of endotracheal intubation. Compared with patients not known or suspected of COVID-19, endotracheal intubations of patients with known or suspected COVID-19 were more often performed using video laryngoscopy (88% versus 82%, difference 6.3%; 95% confidence interval [CI], 3.0% to 9.6%) and passive nasal oxygenation (44% versus 39%, difference 5.1%; 95% CI, 0.9% to 9.3%). First-pass success was not different between those who were and were not known or suspected of COVID-19 (87% versus 86%, difference 0.6%; 95% CI, -2.4% to 3.6%). Adjusting for patient characteristics and procedure factors in those with low anticipated airway difficulty (n=2,374), adverse events (most commonly hypoxia) occurred more frequently in patients with known or suspected COVID-19 (35% versus 19%, adjusted odds ratio 2.4; 95% CI, 1.7 to 3.3).ConclusionCompared with patients not known or suspected of COVID-19, endotracheal intubation of those confirmed or suspected to have COVID-19 was associated with a similar first-pass intubation success rate but higher risk-adjusted adverse events.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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