Patients with Covid-19 and severe hypoxemia may pose a considerable challenge for the pre-hospital emergency medical services. Intubation may be associated with a high risk of complications in these patients and should be carried out with diligence when considered necessary.

Three cases with similar clinical presentation were identified within the Norwegian national helicopter emergency medical service (HEMS) system.

The following interventions are worth considering in Covid-19 patients with refractory hypoxemia before proceeding to intubation.

First, administering oxygen via a tight fitting BVM with an oxygen flow rate that exceeds the patient’s ventilatory minute volume.

Second, applying continuous positive airway pressure, while simultaneously maintaining a high FiO2 .

Finally, assuming the patient is cooperative, repositioning to prone position.

Read More