Early Intubation and Increased Coronavirus Disease 2019 Mortality: A Propensity Score-Matched Retrospective Cohort Study

Austin J Parish; Jason R West; Nicholas D Caputo; Trevor M Janus; Denley Yuan; John Zhang; Daniel J Singer

doi:10.1097/CCE.0000000000000452

Early Intubation and Increased Coronavirus Disease 2019 Mortality: A Propensity Score-Matched Retrospective Cohort Study

Crit Care Explor. 2021 Jun 15;3(6):e0452. doi: 10.1097/CCE.0000000000000452. eCollection 2021 Jun.

Authors

Austin J Parish^{1

2}, Jason R West¹, Nicholas D Caputo¹, Trevor M Janus¹, Denley Yuan¹, John Zhang¹, Daniel J Singer¹

Affiliations

¹ Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.
² Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA.

Abstract

Objectives: There has been controversy about the timing and indications for intubation and mechanical ventilation in novel coronavirus disease 2019. This study assessed the effect of early intubation and mechanical ventilation on all-cause, inhospital mortality for coronavirus disease 2019 patients.

Design: Multicenter retrospective cohort study.

Setting: Eleven municipal hospitals in New York City from March 1, 2020, to December 1, 2020.

Patients: Adult patients who tested positive for coronavirus disease 2019 in the emergency department were subsequently admitted. Patients with do-not-intubate orders at admission were excluded.

Interventions: Intubation within 48 hours of triage and intubation at any point during hospital stay.

Measurements and main results: Data from 7,597 coronavirus disease 2019 patients were included; of these, 1,628 (21%) were intubated overall and 807 (11%) were intubated within 48 hours of triage. After controlling for available confounders, intubation rates for coronavirus disease 2019 patients varied significantly across hospitals and decreased steadily as the pandemic progressed. After nearest neighbor propensity score matching, intubation within 48 hours of triage was associated with higher all-cause mortality (hazard ratio, 1.30 [1.15-1.48]; p < 0.0001), as was intubation at any time point (hazard ratio, 1.62 [1.45-1.80]; p < 0.0001). Among intubated patients, intubation within 48 hours of triage was not significantly associated with differences in mortality (hazard ratio, 1.09 [0.94-1.26]; p = 0.26). These results remained robust to multiple sensitivity analyses.

Conclusions: Intubation within 48 hours of triage, as well as at any time point in the hospital course, was associated with increased mortality in coronavirus disease 2019 patients in this observational study.

Keywords: coronavirus disease 2019; intubation; mechanical ventilation; mortality; retrospective cohort; severe acute respiratory syndrome coronavirus-2.