Current status and adverse events of tracheal intubation for patients with COVID-19 in emergency department: A multicenter cohort study

Background: During the COVID-19 pandemic, the demand for tracheal intubations increased in emergency departmeants (EDs). We aimed to describe tracheal intubations during the COVID-19 pandemic in Japan and investigate the association between COVID-19 and intubation-related adverse events in EDs. Methods: This is an analysis of a prospective observational multicenter study involving patients who underwent tracheal intubations in the ED between April 2020 and March 2023. Patients were divided into two groups: the COVID-19 group and the non-COVID-19 group. To examine the association between COVID-19 and the risk for adverse events during tracheal intubation, a multivariable logistic regression analysis was performed. Major adverse events were defined as cardiac arrest, hypotension, hypoxemia, and dysrhythmia. Results: At 14 institutions, 1984 patients underwent tracheal intubations in the ED (287 in the COVID-19 group and 1697 patients in the non-COVID-19 group). Despite a significantly higher rate of first-attempt intubation success in the COVID-19 group, the incidence of peri-intubation adverse events was significantly elevated compared to the non-COVID-19 group (51.6 % vs. 17.1 %; p < 0.001). Hypoxemia was the most common adverse event. Multivariable regression analysis revealed that the COVID-19 group was significantly associated with a higher risk of adverse events (adjusted odds ratio, 1.69; 95 % confidence interval, 1.17–2.42; p = 0.005). Conclusions: Patients with COVID-19, though undergoing successfully intubations, remained at disproportionately higher risk for critical complications during airway management.