Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

Br J Anaesth. 2020 Jul;125(1):e28-e37. doi: 10.1016/j.bja.2020.03.026. Epub 2020 Apr 10.


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.

Keywords: ARDS; COVID-19; airway management; consensus recommendations; critical care; infection prevention and control; pneumonia; respiratory failure; tracheal intubation.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Betacoronavirus*
  • COVID-19
  • China
  • Coronavirus Infections / complications
  • Coronavirus Infections / prevention & control
  • Coronavirus Infections / therapy*
  • Female
  • Humans
  • Hypotension / etiology
  • Hypoxia / etiology
  • Intubation, Intratracheal / methods*
  • Male
  • Pandemics / prevention & control
  • Personal Protective Equipment*
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / prevention & control
  • Pneumonia, Viral / therapy*
  • Pneumothorax / etiology
  • Practice Guidelines as Topic
  • Retrospective Studies
  • SARS-CoV-2