Mandatory Intubation of Patients Undergoing Thrombectomy: Clinical De - cision Model for Reducing COVID-19 Exposure

Abstract

Background and Purpose— Our aim was to determine the value of mandatory intubation in patients requiring
thrombectomy as a means for reducing in-hospital exposure for undiagnosed corona virus disease 2019 (COVID-19)
among acute ischemic stroke patients, and the factors that influence this decision.
Methods— We constructed two probabilistic decision trees, one addressing the potential benefit to the patient, and
the second addressing the potential benefit to the medical professionals involved in direct patient care. We based the
model on the role of endotracheal intubation within the scope of using thrombectomy for acute stroke treatment, and
its impact on the exposure of medical professionals.
Results— The utility of mandated intubation for acute ischemic stroke patients prior to mechanical thrombectomy
is inferior to that of undergoing such procedure only if clinically indicated (5.53 vs. 6.00 QALYs). Only two of the
input variables (i.e. the case fatality rate and disability from acute ischemic stroke) were found to have threshold
values within their plausible ranges, although very close to their highest values. Both extreme analyses also demon
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strated the superiority of avoiding mandatory endotracheal intubation in patients, irrespective of setting the values
of the input variable with a bias to benefit compulsory intubation (5.81 vs. 5.74 QALY), or with a bias disfavoring it
(5.90 vs. 4.15 QALY).
Conclusions— Our analysis does not support mandatory intubation in every acute ischemic patient prior to me
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chanical thombectomy. Based on our assumptions, intubation based on clinical need as used prior to COVID-19
pandemic appears to be the superior approach.