Clinical Experience with Emergency Tracheal Intubation and Outcomes in Patients Infected with Coronavirus Disease 2019 at a Tertiary Neurological Center in Thailand
Keywords:
cardiac arrest, cardiopulmonary resuscitation, coronavirus disease 2019 (COVID-19), outcome, SARS-CoV-2, tracheal intubationAbstract
Background: The study aimed to summarize the outcomes of a patient infected with coronavirus disease 2019 (COVID-19) following emergency tracheal intubation admitted to the tertiary neurological hospital in Thailand during a rapidly evolving COVID-19 pandemic situation with limited knowledge, a shortage of medical personnel, and inadequate medical equipment. Methods: A single-center, cross-sectional retrospective observational study was done from 16 March 2020 to 30 September 2021. The data were recruited from COVID-19 patient’s medical records who had emergency tracheal intubation, including the demographics, severity of COVID-19 disease, type of oxygen therapy, COVID-19 treatment, Laboratory findings within 48 hours before intubation, outcomes after tracheal intubation, and hospital length of stay. The descriptive statistics and nonparametric statistical test were analyzed. Results: Nine hundred and thirty-one COVID-19 patients were admitted. Twenty-four patients (2.6%) required emergency tracheal intubation; three patients (12.5%) were intubated during emergency cardiopulmonary resuscitation (CPR). Five patients were transferred to the specialized hospital for the advanced intensive care unit. Eighteen patients suffered sudden cardiac arrest, and 50% (n=9) died within 24 hours after intubation. With significantly lower median PaO2/FiO2 ratio (PF ratio) and higher D-dimer levels, only one patient was successfully weaned from the ventilator and discharged from the hospital. Conclusion: During limited crisis care for critically ill COVID-19 patients, the survival rate after tracheal intubation was poor.
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