• Wenlong Yao, Tingting Wang, Bailin Jiang, Feng Gao, Li Wang, Hongbo Zheng, Weimin Xiao, Shanglong Yao, Wei Mei, Xiangdong Chen, Ailin Luo, Liang Sun, Tim Cook, Elizabeth Behringer, Johannes M Huitink, David T Wong, Meghan Lane-Fall, Alistair F McNarry, Barry McGuire, Andrew Higgs, Amit Shah, Anil Patel, Mingzhang Zuo, Wuhua Ma, Zhanggang Xue, Li-Ming Zhang, Wenxian Li, Yong Wang, Carin Hagberg, Ellen P O'Sullivan, Lee A Fleisher, Huafeng Wei, and collaborators.
• Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• Br J Anaesth. 2020 Jul 1; 125 (1): e28e37e28-e37.

AbstractTracheal 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.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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