Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress

• DOI: 10.5811/westjem.2021.3.50116
• Publication Date: 2021-07-25T02:10:53Z
• Authors: Zachary Jarou; David Beiser; Willard Sharp; Ravi Ravi Chacko; Deirdre Goode; Daniel Rubin; Dinesh Kurian; Allison Dalton; Stephen Estime; Michael O’Connor; Bhakti Patel; John Kress; Thomas Spiegel
• Keywords: Nasal cannula

Introduction: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting distress and outcomes, including rates endotracheal intubation (ETT), mortality, hospital length stay. Methods: We performed a retrospective, non-concurrent cohort ED who required HFNC or ETT in within 24 hours following departure. Comparisons were made before after introduction an ED-HFNC protocol. Results: Use was associated reduced rate (46.4% vs 26.3%, P <0.001) decreased cumulative proportion departure (85.7% 32.6%, their entire hospitalization (89.3% 48.4%, <0.001). Using also trend toward increased survival discharge; however, not statistically significant (50.0% 68.4%, = 0.115). There no impact on intensive care unit Demographics, comorbidities, illness severity similar both cohorts. Conclusions: The institution protocol reductions ETT. Early initiation is promising strategy avoiding improving outcomes