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 vestigate 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: COVID-19 group and the non-COVID-19 group. To examine the association between COVID-19 and the risk adverse events during tracheal intubation, a multivariable logistic regression analysis was performed. Major verse 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 cess 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. tivariable regression analysis revealed that the COVID-19 group was significantly associated with a higher risk 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. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar nologies.