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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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., Wong, D., Lane-Fall, M., McNarry, A., McGuire, B., Higgs, A., Shah, A., Patel, A., Zuo, M., Ma, W., Xue, Z., Zhang, L., Li, W., Wang, Y., Hagberg, C., O'Sullivan, E., Fleisher, L., Wei, H., Peng, Z., Liang, H. & Nishikawa, K. 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), pp. 28-37. https://doi.org/10.1016/j.bja.2020.03.026

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Last updated: 17 June 2022
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